ObGyn
Missed Concepts
- Obesity is a risk factor for POP, but weight loss is not an effective management option. Instead consider pessary or surgery.
- Scuba diving is not recommended during pregnancy.
- It's ok to start a new exercise regimen after becoming pregnancy.
- Patient's who are at high risk of preeclampsia (SCD, HTN, nephropathy) should have early 24 hr protein collection to establish baseline.
- Indications for antibiotic ppx in patients who are GBS unknown: < 37 weeks, ROM > 18 hrs, intrapartum fever
- Diagnosis of placenta previa in a patient without prenatal care and with current bleeding: TVUS or speculum exam (these are actually safe because they don't go in the endocervical canal)
- Self breast exams are never recommended.
- POP can cause abnormal uterine bleeding.
- Treat cerebral venous sinus thrombosis with LMWH (even in the presence of a hemorrhage)
- Kleihauer-Betke test calculates the percentage of fetal blood cells in the maternal circulation to determine dose of Rhogam
- Acute cervicitis is most commonly caused by chlamydia or gonorrhea
- UTI (and asymptomatic bacteriuria) treatment in pregnancy: get a urine culture; treat with Fosfomycin (single dose), Augmentin (5-7 days), Cephalexin or Cefpodoxime (5-7 days); Test for cure one week after completion of antibiotics.
| Disease | AFP | Estriol | hCG | Inhibin | Mnemonic |
|---|---|---|---|---|---|
| Down (trisomy 21) | Low | Low | High | High | HIgh |
| Turner (45 X,O) | Low | Low | High | High | HIgh |
| Edward (trisomy 18) | High | Low | Low | High | HE is low |
| Patau (trisomy 13) | High | Low | Low | Low | AFPatau is High |
Abnormal Labor
- 1st stage (painful contractions leading to cervical dilation)
- Latent Phase (0-6 cm dilation): Protraction of latent phase is defined as greater than 14 hours (multip) or 20 hours (nullip) without change in dilation.
- Active Phase (6-10 cm dilation): Protraction of active phase is defined as ≤1 cm dilation in 2 hr; manage with Pitocin. Arrest is defined as no change in 4 hours (with adequate contractions) or 6 hours (without adequate contractions); management includes placing an IUPC catheter to determine if contractions are adequate, if yes: C-section, if no: AROM or Pitocin.
- 2nd stage (active pushing)
- Arrest is defined as no change in fetal station in 1-3 hrs (depending on parity and use of neuraxial anesthesia); management is to reduce epidural rate, give Pitocin, consider C-section or forceps delivery.
- 3rd stage (delivery of the placenta)