Creog-OB

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risk of uterine rupture with prior low transverse incision

0.5-0.9%

risk of transmission of HIV if viral load < 1000 for HIV

1-2%

3 main reasons for pLTCS

1. FTP 2. NRFHT 3. malpresentation

3 highest risk factors for abruption

1. h/o abruption 2. AMA 3. cHTN

recurrence risk of shoulder dystocia

10%

Nuchal translucency

10-13w, Require CRL between 38 and 84mm. >or equal to 3.0mm, or >99%ile for CRL. 1/3 with increased translucency will have aneuploidy

chorionic vilous sampling gestational age. Risk of fetal loss?

10-14w, 1:455

amount of iron intake required in pregnancy

1000 mg total or 27 mg a day

two dose regimen for mtx

50mg/m2 IM day 1 and day 4. measure hcg day 4 and 7. if it does not increase >15% give third dose on day 7. recheck hcg day 11. Can give up to 4 doses. give to women with higher starting hcg (3600)

dose of methotrexate

50mg/m2 IM, hcg must fall by at least 15% after 7 days, measure bhcg on day 4 and 7. May administer another dose, then surgery

When to delivery for BPP score

6/10: deliver of >37w, if <37w repeat in 24 hr oligohydramnios= deliver if >36w 4/10: deliver is >32w <4/10: deliver

how far into a pregnancy can a medical abortion occur?

63 days

magnesium dose for neuroprotection magnesium dose for tocolysis

6g bolus with 2g/hr is <32 w 6g bolus

Dexamethasone steroid dose for PTL

6mg x4 IM, q12h

when to place an IUD PP

6w

abx treatment for PPROM

7 days total of IV ampicillin and erythromycin (first 2 days) followed by PO amoxicillin and erythromycin (or azythromycin) during expectant management only give if >20w

Test to determine if vaginal bleeding is fetal blood

Apt test

false positive nitrazine

BV, blood, semen, soap

Causes of echogenic bowel

CF, CMV, Down syndrome, aspiration of blood.

requirements for cephalic/breech vaginal deliver

EFW >1500g Baby A lager than B Twin discordance <20% No more than 2 prior c/s

delivery of diabetic mothers

GDMA1- by 41w GDMA2 well controlled- 39w GDMA2 uncontrolled- 37-38w pregestational diabetes- controlled 39w uncontrolled- 37-38w

Which Hgb is aftected by beta thalasemia?

Hgb A= alpha2beta2 Increased Hgb F= apha2delta2

treatment for breast abscess

I&D Vanc to cover MRSA or Bactrim

contraindications to tocolysis

IUFD, lethal fetal anomaly, NRFHT, severe PreE or E, maternal instability, chorio, PPROM, multiple gestations, (abruption?)

tx of ITP

IVIG, dexamethasone, or prednisone when platelets are < 30,000 >50,000 for c/s >80,000 for epidural

Rh antibodies and antigens

IgG, crosses the placenta antigens= C, c, D, E, e

epidural location

L4-L5

rates of delivery of PTL

30% resolve spontaneously <10% deliver in 7 days 50% deliver at term

Dose of rhogam

300 mcg coveres 30 cc of fetal rbcs 50-120 mcg if <12w

when to deliver mono-mono twins

32-34w, always by c/s to prevent cord entanglement

when to deliver placenta accreta

34-36w

when to deliver mono-di twins

34-38w

when to deliver vasaprevia

35-36w

when to deliver if h/o prior uterine rupture

36-37 w

when to deliver if h/o classical c/s or h/o uterine rupture

36w

when to switch from heparin to LMWH

36w

when to deliver chtn with no complications

38-39w

when to deliver di-di twin

38w

when to do C/s for HIV

38w if viral load >1000

how long does it take for a uterus to completely involute

4 weeks

when to restart anticoagulation

4-6 hr after vaginal delivery 6-12 hor after c/s 4 hr after removal of epidural 24 hr after spinal

magnesium dose for preE

4g, 2g/hr 6g if eclampsia if eclampsia and already on mag, give a 2g bolus.

when does the neural plate form?

5 weeks

maternal caloric requirement for breastfeeding

500 calories daily

average blood flow to uterus at term

500 cc/min

Listeria treatment and symptoms

abscesses in fetus and placenta- culture placenta exposure= test if symptomatic symptoms but no fever= BCx and exp managment Febrile= BCx and ampililin IV 2g q4h, 7 days

treatment for varicella

active lesions in pregnancy- oral acyclovir within 24 hr maternal pneumonia= IV acyclovir infants who develops varicella by 2w of life= IV acyclovir mother develops varicella 5days prior-2 days PP= treat infant with VZIg Pregnancy exposure= VZIg and acyclovir within 72 hours

most common site of ectopic implantation

ampulla

when to use vaginal progesteron

asymptomatic with no history of preterm birth and cervical length <20mm at <24w

when to do a classical c section for transverse lie

back down

Neonatal encephalopathy

base excess >12, pH<7, 2 MRI showing injury, metabolic acidosis

delayed cord clamping in preterm infants

better blood volume, lower incidence of necrotizing enterocolitis, lower incidence of intraventricular hemorrhage

absolute contracindications to methotrexate

breastfeeding, immunodeficiency disorder, alcoholism, chronic liver disease, anemia, leukopenia, thrombocytopenia, sensitivity to methotrexate, active pulmonary disease, peptic ulcer disease, renal disease, intrauterine pregnancy, reptured ectopic, hemodynamic instability

erb palsy klumpkies palsy

c5-c6 c7-t1

tx for transfusion associated citrate toxicity

calcium chloride causes hyperkalemia, hypocalcemia, and acidosis

risk of indomethacine

can constrict ductus ateriosus and cause necrotizine enterocolitis

US indicated cerclage

cervical length <25mm between 16-24w and history of preterm delivery at <34w

Prerequisites for operative vaginal delivery

cervix fully dilates membranes ruptured engagement of the fetal head determine position of fetal head estimate fetal weight pelvis thought to be adequate for vaginal birth adequate anesthesia maternal bladder empty patient agree to risks and benefits willingness to abandon operative delivery with backup in place

what has the highest risk of fetal-maternal hemorrhage

chorionic villus sampling

changed in cervix in labor

collagen breakdown, glycosaminoglycans, increased cytokins, wbc infiltration

ultrasound findings diagnostic of pregnancy failure

crown-rump length > or equal to 7mm and no heartbeat mean sac diameter of > or equal to 25mm and no embryo abscence fo embryo with heartbeat 11 days or more after a scan that showed a gestations sec with a yolk sac absence of embryo with heartbeat 2 weeks or more after a scan that showed a gestational sac without a yolk sac

day of separation causing what twin type

day 1-3= di di day 3-8= mono-di day 8-13= mono-mono day 13-15= conjoined >15 days= singleton fetus

systemic vascular resistance in pregnancy

decreases due to progesterone. Decrease peaks at 24 weeks and slowly returns to pre-pregnancy BP. should never exceed it

indication for cerclage

history of cervical insufficiency history of cerclage for painless cervical dilation in the 2nd T painless cervical dialation in the 2nd T cervical length <25mm <24w with history fo preterm birth <34w

side effect of oxytocin bolus

hypotension

MCA velocity

if MCA is > 1.5 MoM, transfuse through PUBs

causes of hydrops

immune= Rh or Kell Non-immune= infectious, cardiac (SVTs), aneuploidy, TTTS, sacrocoxygeal teratoma Must have 2 (skin, amniotic fluid, ascites, cardiac, pulm)

hcg levels that indicated ectopic

increase in hcg, plateau, or decrease<15%

treatment for latent TB w/ average progression risk Latent TB w/ elevated progression risk Active TB

isoniazide w/ B6 for 9 mo started 2-3 mo after delivery insoniazide w/ B6 for 9 mo after first trimester Isoniazide w/ B6 and rifampin for 9mo +/- ethambutol

most common sex chrosomsome aneuploidy

klinefelter syndrome

breech maneuvers

loveset= flex elbow to sweep arm down past the face mauriceau= press on maxillae to flex head pinard= fetal thigh, flex knee, move laterally, deliver foot prague= used if fetal back is posterior to deliver legs while keeping head flexed

kronig incision

low veritcle incision

General anesthsia in labor

main risk is hypotension minimal effects on newborn can begin breast feeding right away

what causes complete heart block

maternal SSA and SSB IG crossing placenta in lupus More likely to be Anti-Ro than Anti-La

Criteria for chorio

maternal fever AND: maternal leukocytosis purulent cervical drainage fetal tachcardia

side effects of epidural

maternal tachycardia, hypotension, increased maternal temperature

treatment of ovaries in turner syndrome

may contain gonadoblastomas. remove prior to puberty. Give HRT with estrogen. Give progesterone for breakthrough bleeding. Add progesterone at puberty, will cause breast growth

which type of episiotomy is recommended?

mediolateral

which face presentation can be delivered vaginally?

mentum anterior

dose of blood loss drugs

methergine IM 0.2mg q2-4hr, can cause N/V hemabate IM 0.25 mg q 15min, 8 ose max

methergine

methylergonovine, 0.2mg IV

how to induced prior to 28 weeks

misoprostol is best option. After, manage like any other laborer, cook balloon in a good option

autonomic dysreflexia

most serious medical compication in women with spinal cord injuries above T6. Treat with neuraxial anesthsia. Severe hypertension, cardiac arrhythmias, HA, sweating, massive sympathetic response

contraindication to magnesium

myasthensia gravis

amoxicillin-clavulanic acid (augmentin) is associated with what in pregnancy?

necrotizing encterocolities

contractions stress test results

negative= no decels positive= decels with >50% of ctx equivocal-suspicious- intermitent decels equivocal= decels with ctx >2 min apart or >90s, hyperstimulatory unsatisfactory= <3 ctx in 10 min

histologic change in dilating cervix

neutrophils release protease hyaluronan draws in water collagen reduced 30-50%

treatments for GBS

no allergy= pen G 5 mil U loading, 3 mil U q4h low risk allergy= ancef 2g loading, 1g IV q8h Anaphylaxis clinda susceptible= clinda 900 mg IV q8h Anaphylaxis resistant or unknown= van 20 mg/kg q8h

risk of accreta with a previa

no prior c/s= 3% 1 prior= 11% 40% 61% 67%

risk factors for postterm pregnancy

nulliparity prior post term pregnancy male fetus maternal obesity anencephaly placental sulfatase deficiency

risk factors for post-term pregnancy

nulliparity, prior post term pregnancy, male fetus, materanl obesity, anencephaly, placental sulfatase deficiency

gastroschisis vs omphalocele

omphalocele is midline. Associated with other genetic abnormalities Gastroschisis- right of midline. sporadic. C/s not necessary. Related to IUGR

Diagnosis of antiphospholipid syndrome

one clinic criteria and one laboratory criteria clinical: vascular thrombosis 1 or more fetal death after 10w 1 or more births <34w due to preE, E, IUGR 3 or more unexplained fetal loses <10w laboratory: lupus anticoagulant x2 12 w apart anticardiolipin ab of IgG or IgM x2 12 w apart Anti-B2 glycoprotein 1 of IgG or IgM x2 12 w apart

when to give rescue steroids

only if <34w and >7 days prior

when to tocolyse PTL

only through steroid window <34w

what is 1:1:1?

pRBC, FFP, and cryo

which SSRI causes congenital malformations?

paroxetine, cardiac malformations

Other meds in eclampsia

pheytoin, amobarbital, thiopental

membrane stripping releases what?

phospholipase A2 and PGF2a

suture used for cerclage

polydioxanone (PDS) uncoated polymer

how long to wait for LEA after lovenox and heparin

prophylactic lovenox= 12 hr theraputic lovenox= 24 hr prophylactic heparin= 4-6hr theraputic heparin= 12 hr

hemabate

prostin, PGF2, 15-methylprostaglandin F2alpha IV 0.25mg q15min x 8 doses

diagnosis of T2DM in normal female

random glucose > or equal to 20 fasting glucose > or equal to 126 2hr gtt > or equal to 200 A1c > or equal to 6.5%

High spinal

regional anesthesia travels higher than expected into the chest. Causes hypotension, nausea, vomiting, loss of consciousness, aspiration, airway compromise. Tx= L lateral uterine displacment, pressors, respiratory support. Caused by intrathecal injection instead of epidural, trendelenburg

is gadolinium MRI safe?

safe in breast feeding not safe in pregnancy, risk of rheumatologic disease in fetus

chorio most sensitive and specific test

sensitive= IL-6 specific= culture

TOLAC with twins

similar outcomes to singletons

maylard incision

similar to pfannensteil but the rectus ot dissected away from the rectus abdminis muscles and the bellies of the muscles are transected. require ligation of the inferior epigastric vessels

kuster incision

slighyl curved, below ASIS, just below pub hair line

treatment for mastitis

staph aureua dicloxacillin 500 mg x10-14 days

when do neural tube defects occur

start at 5 weeks, close by 6 weeks

joel-cohen incision

straight transverse incision, 3cm below ASIS

what acute treatments are best for systolic vs diasolic bp

systolic- labetalol diastolic- hydralazine and nifedipine

Best way to prevent nausea in pregnancy

take PV one month prior to conveing

cherney incision

tends of the rectus abd and pyramidalis are transected 1-2 cm above their insertion at the pubic symphysis, lifted cephalad

preexposure prophylaxis for HIV

tenofovir and emtricitabine

treatment for septic pelvic thrombophlebitis

theraputic heparin or LMWH for 7-10 days

only features of preE that require delivery even if not steroids

uncontrolled severe HTN, eclampsia, pulmonary edema, abruption, DIC, NRFHT, intrapartum fetal demise

relative contraindications to methotrexate

unruptured mass <4cm, no fetal cardiac motion, hcg <5,000, refusal to except blood transfusions, hcg rising by >50% in 48hr

how long can a delayed PP hemorage occur

up to 12 w PP

risk of rupture after previous uterine rupture

upper segment= 32% lower segment= 6%

spinal headache

worse when standing. Casued by leakage of CSF

calculate vials of rhogam

(% fetal cells x 5000 cc)/ 30cc + 1 vial

alpha thalasemia major

(a-/--) hemoglobin H, moderate anemia (--/--) Hb Barts, hydrops fetalis, IUFD, PreE

when to deliver placenta previa

36-37 weeks

what to order next if HBsAg is positive

HBV core antigen IgG and Ig, LFTs, viral load

critical titers for anti-D When to give rhogam

between 1:8 and 1:32, if <1:8, follow every 4 weeks for testing If paitent has Ati-D and is bleeding, gets titers, dont give rhogam

contraindications to operative delivery

bone demineralization, bleeding disorders

contraindications to cell saver

bovie electrocautery= carbon monoxide Clotting agents= surgical fat contamination irrigating solutions= betadine

when to give rhogan

delivery, SAB, ectopic, cordocentesis, amniocentesis, CVS, ECV, trauma, hemorrhage. Give of > 0.1cc blood loss

abx for suction D&C

doxycyline 200 mg 1 hour prior to D&C

exam indicated cerclage

emergent cervix 1-4cm dilated and <24w with NO history of preterm delivery

what is in cryoprecipitate

factor VIII, XIII, fibrinogen, and VWF

most common sign after uterine rupture

fetal bradycardia

compound presentation

fetal vertex along with fetal extermity presenting

fetal blood volume at term with and without placenta

fetus= 78 cc/kg fetus + placenta= 125 cc/kg

treatment for endomyometritis

gent and clinda amp treats enterococcus

post exposure prophylaxis for HIV

given < 72 hours, tenofovir/emtricitabine and raltegravir

what do you do if a 4th degree lac is later found in clinic?

go to the OR to repair

baseline preterm birth rate in US

12%

when are cerclages placed?

12-14weeks

when does fetus start to develop is own thyroid hormone

12w

risk of alloimmunization if mom does not get rhogam

13%

when to offer vaginal progesteron

16-24w h/o PPROM CL <20mm

twin risk of death and nerologic injury for mono-di and di-di if one twin dies

18% neurologic injury in mono-di 15% death in mono-di 3% death in di-di 1% neurologic injury in di-di

risk of down syndrome at age 35

1:190

Most predictive US measurment of gestational age?

1st T CRL 2nd T head circumference 3rd T femur length (cerebellum)

excess bleeding after MAB

2 pads per hour for 2 hours

radiation exposure that causes congenital anomalies

20 Rads

dose of mifepristone for early pregnancy loss

200 mg PO 24 hours before misoprostol

quad screen results for trisomy 21 and 18

21= decreased MSAFP and estriol. Increased beta-hcg and inhibin A 18= decreased all

when can you use FFN

22-34w Low PPV, high NPV dont use with vaginal bleeding or advance dilation Can be used in twins can use if recent intercourse

amount of iodine intake in pregnancy vs breastfeeding

220 ug 290 ug when breastfeeding

discriminatory bhcg level to visualize a pregnancy

3,500

Rhogam dosage

<12w 50-120 ug >12w 125-300 ug

what membrane thickness between amniotic sac indicated monochorionic twins

<2mm

what gestational age is rhogam not indicated

<7w

US discrepancy in dating

<9w use US if >5 day difference 9-16w, >7 days >16w, >10 days 16-28w, 14 days Third trimester, 3 weeks

what gestational age can you do amniocentesis? Risk of fetal loss?

>14w, 1:370-1:900

when to give an additional dose of ancef

>1500cc blood loss or > 4 hr

when to start combined OCPs postpartum

>3 weeks PP, increased risk of DVT. best if 6w

when do you expect to see accelerations 15x15

>32 weeks <32 weeks= 10x10

bishop score consistent with favorable cervix

>8 (9 or more)

Noonan syndrome

AD, PTPN11 gene, Short stature, characteristic facial features, pulmonic stenosis, lymphatic dysplasia, intellectual disability, pectus deformity, coagulation defects, renal abnormalities.

nifedipine dose for tocolysis terbutaline dose

PO 30mg loading, then 10-20mg q4-6hr 0.25mg q20min

stages of TTTS

Stage 1= poly MVP >8cm in one twin and oligo <2cm in the other stage 2= donor's bladder is not visible stage 3= umbilical artery doppler are abnormal stage 4= hydrops stage 5= fetal death


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