HTN class of medications contraindicated in pregnancy
ACE inhibitors (e.g. captopril)
Category D: worst in second and third trimester
Complications: oligohydramnios, renal agenesis, fetal skull abnormalities, and increased risk of stillbirth
Angiotensin receptor blockers (ARBs), such as losartan.
Which class of antibiotics is associated with fetal kernicterus when taken near term in pregnancy?
Sulfonamides
Painless, bright red vaginal bleeding in the second or third trimester
Placenta previa
Placenta previa risk factor
Previous caesarean section
Also: Maternal age > 40 years, grand multiparity, previous placenta previa, multiple gestations, previous multiple induced abortions, and preterm labor
What is the gold standard for diagnosis of placenta previa?
Ultrasound
A 32-year-old woman presents with persistent nausea over the last two weeks. She is approximately 10 weeks pregnant. She has been able to tolerate fluids, but has had decreased food intake. She denies any abdominal or pelvic pain or vaginal bleeding. What medication is considered first-line treatment for this patient?
Pyridoxine (water-soluble B complex vitamin)
+/- Unisom (doxylamine)
What electrolyte abnormalities can be seen in patients with hyperemesis gravidarum?
Hypokalemia with a hypochloremic metabolic alkalosis
What is the preferred outpatient treatment of hypertension in pregnancy?
Methyldopa is started at a dose of 250 mg PO BID and titrated to effect.
Labetalol is another recommended agent, and is started at 100 mg PO twice a day.
What are the diagnostic criteria for preeclampsia?
Hypertension after 20 weeks of pregnancy plus proteinuria or other signs of end-organ dysfunction
Eclampsia treatment
- Loading dose of 6 grams over 20-30 minutes
2. Followed by a continuous infusion of 2 g/hr.
Umbilical cord prolapse preferred delivery method?
C/S
Umbilical cord prolapse - What do you do if you have no OB and they are far away?
- Perform maneuvers to preserve umbilical circulation.
- The patient should be placed in the knee-chest position with the bed in Trendelenburg.
- The presenting part is digitally elevated off the umbilical cord.
- The umbilical cord is manually replaced into the uterus.
- Prepare for rapid vaginal delivery.
Molar pregnancy findings
- The uterus is enlarged greater than one would expect based on dates.
- B-hCG levels are also higher than one would expect, often > 100,000 mIU/mL.
- Absence of an embryo or fetus, ovarian theca lutein cysts, and hydropic vesicles within the uterus, described as a “snowstorm” appearance.
What is the treatment of choice of low-risk gestational trophoblastic neoplasia?
Chemotherapy using either methotrexate or actinomycin D.
Painful vaginal bleeding and evidence of fetal distress in the third trimester.
Placental abruption
Placental abruption labs show?
Labs will show hypofibrinogenemia
Postpartum hemorrhage EBL
> 500 mL
Most common cause of postpartum hemorrhage?
Uterine atony
Uterine atony treatment?
- Bimanual uterine compression and massage, with one hand inside the vagina pushing upward against the body of the uterus while the other hand pushes downward on the uterine fundus from the abdominal wall.
- Oxytocin.
- Methylergonovine and carboprost can also be used.
Suggestive of preterm rupture of membranes?
Vaginal fluid pH > 6.5
Ferning
Most reliable sign of uterine rupture?
Nonreassuring fetal heart rate pattern is the most reliable sign of uterine rupture.
What is the dose of intramuscular oxytocin for postpartum hemorrhage?
Oxytocin 10 IU IM.
The next most appropriate step when you have shoulder dystocia?
- The mother’s legs should be hyperflexed and pulled up by the abdomen (McRobert’s maneuver) and firm suprapubic pressure applied.
- If this fails to deliver the infant, the mother should be placed in the all-fours position and gentle downward traction applied to the fetal head (Gaskin maneuver).
- Rotational maneuvers such as the Rubin and Woods corkscrew maneuver can also be attempted. These methods are usually done with an episiotomy and involve rotating the infant to allow for delivery.
If an episiotomy needs to be performed, in which direction should the incision be made?
Mediolateral
