Maternal, Fetal, and Neonatal Clinical Care: Stillbirth, Trauma, Infections, Fibroids, and Genitourinary Variations

Comprehensive vocabulary flashcards covering obstetrical, perinatal, dermatological, and neonatal concepts from Week 2 lecture notes and reference sources.

Stillbirth (Fetal Death)

Death prior to the complete expulsion or extraction from the mother of a product of human conception, irrespective of duration of pregnancy and not an induced termination, indicated by the absence of breathing, heartbeat, pulsation of the umbilical cord, or voluntary muscle movements. Most United States reporting mandates apply at $\ge 20\,\text{weeks'}$ gestation or a minimum birthweight of $350\,\text{g}$.

Low-Dose Aspirin (LDA) Post-Stillbirth

A preventive pharmacologic intervention indicated when a prior stillbirth was associated with placental insufficiency, preeclampsia, or fetal growth restriction (FGR); the SOGC recommended dosage is $81\text{--}162\,\text{mg/day}$, ideally initiated prior to $16\,\text{weeks}$ of gestation and continued to $35\text{--}37\,\text{weeks}$ or delivery.

Antepartum Fetal Surveillance Post-Stillbirth

Fetal assessment via nonstress test (NST) or biophysical profile (BPP) starting at $32+0\,\text{weeks}$ or $1\text{--}2\,\text{weeks}$ prior to the gestational age of the index demise for a prior stillbirth occurring at $\ge 32\,\text{weeks}$, accompanied by serial ultrasound screening for fetal growth restriction (FGR) starting after $28\,\text{weeks}$.

Planned Timing of Birth Post-Stillbirth

The standard delivery target for an uncomplicated subsequent pregnancy following stillbirth, established by ACOG at $39+0\,\text{weeks}$; earlier elective delivery between $37+0$ and $38+6\,\text{weeks}$ may be considered in selected cases involving severe parental anxiety following informed counselling regarding neonatal risks, but delivery before $37\,\text{weeks}$ solely for prior stillbirth is not recommended.

Streptococcus mitis

A viridans group streptococcal organism and normal oral commensal that can rarely invade the bloodstream or reproductive tract in pregnancy, leading to chorioamnionitis, maternal bacteremia, preterm birth, postpartum endometritis, or septic symphysitis resulting in chronic lumbopelvic pain and mobility impairment.

Postpartum Endometritis Regimen

A standard intravenous antimicrobial combination providing broad polymicrobial coverage using clindamycin (covering Gram-positive organisms and anaerobes) plus gentamicin (covering Gram-negative aerobes), with ampicillin added if Enterococcus is suspected or if the patient fails to improve.

Hemoglobin A1c (HbA1c) Glycemic Thresholds

Diagnostic and monitoring benchmarks where $<5.7\%$ is normal, $5.7\text{--}6.4\%$ indicates prediabetes, and $\ge 6.5\%$ confirms diabetes; in pregnancy with pre-existing diabetes, the target is $<6.5\%$, ideally $\le 6.1\%$ by the third trimester if achievable without problematic hypoglycemia.

Left Uterine Displacement

Manual leftward displacement or lateral tilt of the gravid uterus applied after mid-pregnancy to relieve aortocaval compression on the inferior vena cava and aorta, preventing up to a $30\%$ decrease in maternal cardiac output.

Maternal Resuscitation Goals in Trauma

The immediate resuscitation strategy prioritizing the pregnant person's ABCDEs, administration of supplemental oxygen to sustain maternal $\text{O}_2$ saturation at $>95\%$, placement of two large-bore intravenous lines ($14\text{--}16\,\text{G}$), and reserving vasopressors solely for intractable hypotension that impairs uteroplacental perfusion.

Trauma Electronic Fetal Monitoring (EFM) Thresholds

Cardiotocographic surveillance required for a minimum of $4\,\text{hours}$ in all viable gestations ($\ge 23\,\text{weeks}$), extended to $24\,\text{hours}$ of observation if uterine contractions exceed $>1$ per $10\,\text{minutes}$, or if abdominal tenderness, bleeding, rupture of membranes, abnormal heart rate patterns, high-risk injury mechanisms, or fibrinogen $<200\,\text{mg/dL}$ are present.

Traumatic Placental Abruption

Premature detachment of the placenta from the uterine wall caused by mechanical deformation or contrecoup shearing forces; often concealed without external bleeding, carries a high risk of maternal hypofibrinogenemia and fetal demise, and cannot be excluded by a negative ultrasound examination.

Kleihauer-Betke (KB) Test

An acid-elution assay performed on maternal peripheral blood to detect and quantify the volume of fetomaternal hemorrhage (FMH) following trauma, used to calculate whether an Rh-negative patient requires supplemental doses of anti-D immunoglobulin beyond the standard initial prophylaxis.

Perimortem Caesarean Delivery (Resuscitative Hysterotomy)

Emergency surgical delivery indicated within approximately $4\,\text{minutes}$ of maternal cardiac arrest in a viable pregnancy ($\ge 23\,\text{weeks}$) to relieve aortocaval compression, restore maternal venous return and cardiac output during CPR, and maximize fetal salvage.

Intimate Partner Violence (IPV) Inquiry: Universal Screening vs. Case-Finding

The clinical divergence in identifying relationship abuse during pregnancy: ACOG/Chisholm recommends universal routine screening at the first prenatal visit, each trimester, and postpartum; the Canadian Psychiatric Association/Stewart recommends a selective case-finding approach prompted by clinical symptoms, injuries, or suggestive circumstances.

Three-Point Automobile Restraint in Pregnancy

The correct vehicular seat-belt configuration for a pregnant occupant, requiring the shoulder harness to lie across the chest above the uterus and between the breasts, with the lower lap belt positioned flat and snug across the upper thighs and well below the uterine dome.

Focused Assessment with Sonography for Trauma (FAST)

A rapid four- to six-view bedside ultrasonographic protocol assessing the perihepatic space (Morison pouch), perisplenic space, pelvis, and pericardium to detect free intraperitoneal fluid or internal hemoperitoneum.

Red Degeneration of Uterine Fibroids

Acute hemorrhagic infarction resulting from a fibroid outgrowing its blood supply during pregnancy-induced enlargement, typically presenting in the first half of pregnancy with localized acute abdominal pain, managed supportively with acetaminophen, short-course NSAIDs before $32\,\text{weeks}$, or opioids without terminating or harming the pregnancy.

Submucosal Leiomyoma

The least common anatomical fibroid subtype that lies directly beneath the endometrium and distorts the uterine cavity, uniquely associated with impaired implantation, subfertility, and elevated first-trimester miscarriage risks.

FIGO Leiomyoma Classification System

An anatomical staging framework categorizing uterine fibroids from Types $0$ through $8$: submucosal (Types $0\text{--}2$, from pedunculated intracavitary to $\ge 50\%$ intramural), intramural (Types $3\text{--}4$), subserosal (Types $5\text{--}7$, from $\ge 50\%$ intramural to pedunculated subserosal), and other/wildcard (Type $8$, including cervical, broad ligament, and parasitic lesions).

Caesarean Myomectomy

Surgical excision of a uterine leiomyoma performed concurrently during a Caesarean delivery by an experienced obstetrician; the presence of a fibroid alone does not constitute an indication for Caesarean birth solely to accomplish its removal.

MRSA Colonization versus Infection

The clinical distinction where colonization indicates the asymptomatic presence of methicillin-resistant Staphylococcus aureus on epithelial surfaces (predominantly the anterior nares or skin) without tissue invasion, whereas infection involves active tissue invasion and clinical inflammatory responses.

Community-Associated MRSA (CA-MRSA)

Methicillin-resistant Staphylococcus aureus infection acquired in an outpatient setting by a person without health-care exposures within the prior year, characteristically presenting as cutaneous furuncles, carbuncles, or abscesses that are frequently mistaken for spider bites.

Bacterial Skin and Soft Tissue Infection (SSTI) Tissue Levels

The anatomical stratification of skin infections distinguishing superficial epidermal processes (impetigo, superficial folliculitis, erysipelas), dermal and subcutaneous collections (ecthyma, furuncles, carbuncles, abscesses, cellulitis), and deep fascial necrosis (necrotizing fasciitis).

Cutaneous Abscess

A localized collection of pus in any skin layer or deep tissue that is typically firm or fluctuant and tender; primary therapeutic management relies on incision and drainage (I&D) for source control, without routine antibiotics needed for uncomplicated cases.

Furuncle

A deep inflammatory nodule centered on a hair follicle ('boil'), typically caused by Staphylococcus aureus, which may progress to suppuration and fluctuance.

Carbuncle

An extensive, deeply indurated cutaneous and subcutaneous infection formed by the confluence of multiple infected hair follicles (furuncles) draining through several follicular openings.

Cellulitis

A spreading, non-purulent infection involving the dermis and extending to the superficial fascia, presenting with localized erythema, warmth, pain, swelling, and ill-defined borders.

Erysipelas

A distinct, superficial form of cellulitis involving the dermis and superficial cutaneous lymphatics, characterized by bright-red, warm, rapidly spreading erythema with sharp, well-demarcated margins, frequently accompanied by fever and systemic symptoms.

Ecthyma

An ulcerative bacterial pyoderma described as a deep form of impetigo, characterized by deep erosions into the dermis beneath adherent crusts.

Dilute Bleach Bath (DBB)

An antiseptic skin suppression strategy used for recurrent bacterial SSTIs, prepared by mixing $1/4\text{--}1/2\,\text{cup}$ of household bleach into a standard bathtub filled with water, soaking for $5\text{--}10\,\text{minutes}$ once or twice weekly followed by moisturizer application.

Disorders/Differences of Sex Development (DSD)

A group of congenital conditions in which the development of chromosomal, gonadal, or anatomic sex is atypical, presenting with genital ambiguity or discordance between prenatal karyotype and phenotypic appearance.

Salt-Wasting Congenital Adrenal Hyperplasia (CAH)

A life-threatening, autosomal recessive endocrine emergency caused primarily by $21\text{-hydroxylase deficiency}$, characterized by impaired cortisol and aldosterone synthesis leading to hyponatremia, hyperkalemia, dehydration, and vascular collapse (often not emerging until the second week of life), accompanied by genital virilization in $46,\text{XX}$ neonates.

17-Hydroxyprogesterone (17-OHP)

An adrenal steroid intermediate measured in serum to screen for and diagnose $21\text{-hydroxylase-deficient}$ congenital adrenal hyperplasia; levels accumulate markedly when the enzymatic pathway to cortisol is blocked.

Micropenis Diagnostic Thresholds

An abnormally small phallus measured as stretched penile length (SPL) from the pubic symphysis to the glans tip under gentle traction; defined as $\text{SPL} <2.5\,\text{cm}$ in term infants by McNamara et al., or $\text{SPL} <2.0\,\text{cm}$ by Indyk.

Clitoromegaly Diagnostic Thresholds

Pathological enlargement of the clitoris in a term newborn; defined by McNamara et al. as a clitoral length $>9\,\text{mm}$ or width $>6\,\text{mm}$, and by Indyk as a length exceeding $>1\,\text{cm}$.

Hypospadias

A congenital malformation of the external male genitalia resulting from incomplete fusion of the urethral folds, characterized by the displacement of the urethral meatus onto the ventral aspect of the penis, scrotum, or perineum.

Anogenital Ratio

An objective measurement of virilization calculated as the distance from the anus to the posterior fourchette divided by the distance from the anus to the base of the phallus; a ratio $>0.5$ indicates virilization and posterior labio-scrotal fusion.

Prader Scale

A five-stage classification system quantifying the degree of external genital virilization, progressing from Stage $1$ (isolated clitoromegaly with normal openings) through varying degrees of labial fusion and urogenital sinus formation to Stage $5$ (complete virilization appearing phenotypic male with penile urethra and nonpalpable gonads).

Hyperemesis Gravidarum

Severe, intractable nausea and vomiting of pregnancy leading to dehydration, electrolyte disturbances (notably hypokalemia), ketonuria, starvation acidosis, and weight loss, representing a diagnosis of exclusion that affects $0.5\text{--}2.1\%$ of pregnancies.

Wernicke Encephalopathy in Pregnancy

A serious, potentially fatal neurological syndrome caused by thiamine ($\text{vitamin B}_1$) depletion in women suffering from protracted hyperemesis gravidarum, presenting classically with the triad of ocular signs (nystagmus/ophthalmoplegia), ataxia, and confusion.