Obstetrics

Obstetrics Times

Prenatal Care First Trimester → Visit every 4 weeks First visit Many tests 9-14 weeks First trimester genetic screening Ultrasound Confirm gestational age Nuchal translucency (↑ in Down Syndrome) PAPP-A (Pregnancy-Associated Plasma Protein A) hCG ± Chorionic villus sampling (10-13w) Second Trimester → Visit every 4 weeks 15-20 weeks Triple/Quad test ± Amniocentesis (11-14w) 16-20...

Postpartum Infection

Definition Temperature ≥38℃ Day 2-10 postpartum ≥2 days Etiology The 7 W’s Womb Endomyometritis Wind Atelectasis Pneumonia Water UTI Walk DVT Pulmonary embolism Wound Incision Episiotomy Weaning Breast engorgement Abscess Mastitis Wonder drugs Drug fever Postpartum Endometritis Risk Factors Emergent C-section PROM Prolonged labor Multiple vaginal exams Intrauterine manipulation...

Hyperemesis Gravidarum

Morning sickness past first trimester Due to ↑ hCG and ↑ Estradiol R/O Molar pregnancy Starvation, Ketonuria, Weight loss Treatment Vitamin B6 Doxilamine Promethazine/Dimenhydrinate Severe Metochlopramide Ondansetron Prochlorperazine Promethazine IM Treat dehydration

3rd Trimester Bleeding

Placenta Previa Risk Factors Previous C-section Previous uterine surgery Multiple gestations Previous episode Presentation Painless vaginal bleeding Spontaneous detection on US before 28w Diagnosis Transabdominal ultrasound No vaginal exam before US! Types Complete Partial Marginal Low-lying placenta (0-2 cm away from cervical os) Vasa previa Treatment...

Prenatal Infections

Group B Strep The only time mother with a positive Group B strep screen doesn’t get intrapartum antibiotic is Planned C-section, NO ROM, NO start of delivery Prophylaxis → Ampicillin Allergic → Erythromycin Hep B Positive Ag C-Section Give baby IVIg and Hep B vaccine right after delivery Breastfeeding ok HIV 2...

OB Operations

C-Section Sodium Citrate → For all C-sections give Na citrate ↓ Gastric acidity Prevent Acid Aspiration Syndrome Indication Elective Previous C-section Classic Transverse Active genital herpes Cervical carcinoma HIV infection Placenta previa Breach Postterm pregnancy Desired Urgent Prolonged Arrest of labor Eclampsia Failed vaginal delivery Erythroblastosis fetalis Emergent Maternal...

Other Medical Disease in Pregnancy (UTI, Thyroid)

Advanced Prenatal Tests

Postpartum Hemorrhage

Definition Bleeding >500ml after vaginal delivery >1000ml after C-section Early PPH → within 24h Late PPH → 24h-6w Etiology Atony Risk Factors Anesthesia Uterine overdistension Multiple gestations Polyhydramnios Prolonged labor Laceration Retained parts Placenta accreta Coagulopathy Diagnosis Enlarged, soft boggy uterus Laceration Retained parts Placenta Accreta (75%) To superficial uterine wall...

Labor Complications

Prolonged Latent Stage Prolonged latent phase Primipara: >20h Multipara: >14h Etiology Sedation Unfavorable cervix Uterine dysfunction (irregular/weak contractions) Treatment Rest Hydration Most convert to spontaneous delivery in 6-12h Protracted Cervical Dilation Slow cervical dilation Active stage No change for 4h >5h long Primipara: <1.2 cm/h Multipara: <1.5 cm/h Etiology Power...

Normal Labor

Electronic Fetal Monitoring (external tacometer) FHR Normal: 110-160 bpm Tachycardia: >160 bpm Hypoxia Maternal fever Fetal anemia Bradycardia: <110 bpm Congenital heart disease Severe hypoxia Uterine hyperstimulation Cord prolapse Rapid fetal decent Variability Absent variability Minimal variability Normal variability Marked variability Sinusoidal variability Acceleration 2 increases in FHR >15...

Fetal Testing

Nonstress Test (NST) 20 mins Mother in lateral tilt position Result Reactive → 15/15. 2 in 20 Fetal movements ≥ 2 FHR acceleration ≥ 2 >15 bpm Lasts 15-20 secs Nonreassuring Fetus asleep → Vibroacoustic stimulation Biophysical Profile (BPP) 30 mins 5 categories (2 point each) NST Chest expansion ≥ 1 Movement...