Pregnancy Complications/abortions

Most common site for ectopic pregnancy

Fallopian tube-most common site (98%)

ectopic pregnancy symptoms

bleeding → (7-14 days after missed period/ at time of period)

pain → unilat stabbing/dull pelvic pain

shoulder pain if intra-abdominal hemorrhage under diaphragm

shock from internal hemorrhage after rupture

the first symptom of almost 20% of ectopic pregnancies

shock

how to dx ectopic pregnancy

1. pelvic exam → normal uterus

2. HCG → should inc by 66% in 48 hours

3. transvaginal US to see if IUP (would be visible is hCG is >2000)

difference between threatened and inevitable abortion

threatened → cervix still closed (could still remain viable)

inevitable → cervix dilated (cant be maintained)

Incomplete vs complete

incomplete → some products of conception remain, cervix still open

complete → all products have left uterus and cervix closes

*uterus firm

what is Fetal death in-utero without expulsion by the uterus

missed abortion

Recurrent abortion

Three successive spontaneous abortions

In deciding to terminate pregnancy, Delay in confirming the pregnancy can have what negative impacts

1. delay in care

2. Reduces opportunities for choice

3. Increases risk for complications

what medical induced abortion method is used for ectopic pregnancy

methotrexate

medical abortion options

1. mifepristone

2. misoprostol

3. methotrexate

what ethnicity has higher chance of dizygotic twins

africans have higher chance than asians

between clomid and Gonadotropins, which fertility drug has higher risk of Dizygotic Twins

gonadotropins

monozygotic twins division times

1. <72 hours: 2 placenta, 2 amniotic sacs

2. 4-8 days: 1 placenta, 2 amniotic sacs

3. 8-13: 1 placenta, 1 amniotic sac

4. >13 days: conjoined twins

what type of twins have highest risk of umbilical abnormalities

monozygotic, monochorionic twins

describe the cord clamping in twin delivery

1st twin → 1 clamp at stump and 1 clamp by placenta

2nd twin → 2 clamps at stump and 2 clamps by placenta

low birth weight

<2500grams

#1 cause of perinatal morbidity & mortality

preterm delivery

What gestational age is generally considered the threshold of fetal viability

23 weeks

what is a direct biochemical predictor of risk for preterm birth.

FFN → Fetal fibronectin

when is betamethazine given for preterm labor

24-34 weeks gestation

which tocolytic is the only one that doesnt require inpatient

terbutaline

whats PPROM?

Prolonged Premature Rupture of Membranes →
It is the rupture of chorioamniotic membrane before labor onset

how to diagnose PPROM

(both from speculum exam)

1. nitrazine → high ph/blue pH paper → positive (amniotic fluid is alkaline

2. fern test → ferning pattern on microscope → positive

Premature delivery ALWAYS has risk of what

hypothermia

Precipitous Delivery

rapid delivery within 3 hours of labor → more risk for trauma and tearing

who usually has Precipitous Delivery

grand multipara pts (>5 births)

green/brown amniotic fluid suggests

meconium (1st stool) passed → indicate fetal distress during labor

when is bleeding considered an Obstetric emergency

3rd trimester

Most common causes of antepartum bleeding

placenta previa and abruptio placentae

most accurate diagnostic tool for Antepartum Bleeding

 ultrasound

what is avergae gestational age is placenta previa usually diagnosed

30 weeks

differentiating symptom of placenta previa vs abruptio placenta

placenta previa → painless bleeding

Abruptio placenta → painful bleeding

Dystocia

difficult childbirth from ineffective uterine expulsion

Indications for forceps delivery

1. Prolonged 2nd stage of labor

2. Suspect fetal compromise

3. Stablize head during breech delivery

Most common operation done in the US

Cesarean

which women should always have repeat c-sections

those who have had classic c-sections

Postpartum hemorhage

loss of more than 500cc of blood following a vaginal delivery

what medications can treat post partum hemorhage

1. Methergine,

2. Hemabate,

3. Pitocin

most common cause of uterine rupture

pervious C-section

how many attempts to replace a uterine inversion before sending to OR

1 time

aerobic bacteria causing postpart infections

1. group b strep

2. enterococcus

3. e.coli

anaerobic organisms that cause postpart infections

1. bacteroides

2. clostridium

when does mastitis usually occur

6-12 weeks postpartum

abx for mastitis

dicloxacillin 10-14 days