DrVirgo
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EARLY Congenital Syphilis:
*Non-immune hydrops
*Macerated skin
*Thrombocytopenia
LATE Congenital Syph:
*Hutchinson teeth
*Mulberry molars
*Saber shins
---ALSO:
Saddle nose
VIIIth nerve dearness
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| DrVirgo
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Abruptio Placenta Triad:
*MCC of Late trimester PAINFUL bleeding
*Normal placental implantation
*DIC
Edited by DrVirgo on 02/04/07 - 06:46 PM
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| DrVirgo
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Placenta Previa Triad:
*Late Trimester bleeding
*Low Segment placental implantation
*NO PAIN
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| DrVirgo
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Vasa Previa Triad:
*ROM
*Vaginal bleeding
*Fetal bradycardia
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| DrVirgo
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Uterine Rupture Triad:
*Late Trimester Bleeding
*Loss of Fetal Heart tracing
*Inability to identify uterine contractions
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| DrVirgo
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Triads of Abortion
THREATENED ABORTION:
*1st trimester bleed
*Sono: Norm. pregnancy
*Internal os CLOSED
---Management: conservative
MISSED ABORTION
*1st trimester bleed
*Sono: NON-viable pregnancy
*Internal os CLOSED
---Manage: D&C and conservative
INEVITABLE ABORTION
*1st trimester bleed
*NO POC passed vaginally
*Internal os DILATED
---Manage: EMERGENCY D&C
INCOMPLETE ABORTION
*1st trimester bleed
*Retained POC, but SOME POC PASSED
*Internal os DILATED
---Manage: EMERGENCY D&C
COMPLETE ABORTION
*1st trimester bleed
*NO POC RETAINED
*Internal os CLOSED
(Note: cervical os closes after all POC are expelled)
--->Thanks again to Aashi for correcting this one.
---Manage: Observe and serial B-hCG
Edited by DrVirgo on 02/04/07 - 06:46 PM
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| DrVirgo
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Diagnosis of PROM
*Post. fornix pooling -clear watery amniotic fluid
*Fluid is nitrazine positive -turns pH sensitive paper blue
*Glass slide drying shows fern positive -ferning pattern when allowed to dry
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| DrVirgo
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Chorioamnionitis
*Maternal fever
*Uterine tenderness
*PROM in the absence of URI or UTI
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| DrVirgo
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PRETERM LABOR TRIAD
*20-36 week prego.
*> 3 UC's in 3 min
*Dilated 2 or more cm or changing
Premature contractions
IF:
*20-36 week prego.
*> 3 UC's in 3 min
***Dilated LESS THAN 2 cm or NOT changing
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| DrVirgo
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Mg Toxicity Triad
* Disappearence of DTR( pateller reflex diminshed is the first sign at levels < or = to 10meq/l of Mg) and muscle weakness
*Pulmonary edema
*Resp depression at levels > 10 meq/l and resp.arrest at levels > 12 meq/l of Mg.
(Note: edited) ---> Thanks to Aashi for correcting this.
Ca Channel blocker toxicity
*Preterm labor tocolysis
*Tachycardia/Hypotension
*Myocardial depression
Beta agonist toxicity
*Preterm labor tocolysis
*Hypokalemia
*Hyperglycemia
Indomethacin Toxicity Triad
*Preterm labor tocolysis
*Oligohydramnios
*Closure of PDA in utero
Edited by DrVirgo on 02/04/07 - 06:38 PM
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| Aashi
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Good work Dr.Virgo..but i do have few suggestions to make:-
Abruptio Placenta Triad:
*MCC of Late trimester PAINFUL bleeding
*Normal placental implantation
*+ /- DIC
COMPLETE ABORTION
*1st trimester bleed
*NO POC RETAINED
*Internal os IS 'CLOSED' (Kaplan has a typo here..u may cross-chk this in williams obs or emedicine http://www.emedicine.com/med/topic3310.htm )
---Manage: Observe and serial B-hCG
Mg Toxicity Triad
*Preterm labor tocolysis
( this is not a sign of toxicity, it is one of the benefits of Mg in preterm labor)
So the triad is :-
* Disappearence of DTR( pateller reflex diminshed is the first sign at levels < or = to 10meq/l of Mg) and muscle weakness
*Pulmonary edema
*Resp depression at levels > 10 meq/l and resp.arrest at levels > 12 meq/l of Mg.
Edited by Aashi on 02/04/07 - 05:56 PM
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| DrVirgo
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[quote=Aashi]Good work Dr.Virgo..but i do have few suggestions to make:-
Abruptio Placenta Triad:
*MCC of Late trimester PAINFUL bleeding
*Normal placental implantation
*+ /- DIC
Absolutely RIGHT. 
Thanks for adding that detail... Actually this is another way we can differentiate Abruptio Placenta from Placenta Previa or Vasa Previa...Although all cause LATE trimester bleeding,
AP will cause PAINFUL bleeding whereas PP and VP will cause painless bleeding... Good point.
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| DrVirgo
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COMPLETE ABORTION
*1st trimester bleed
*NO POC RETAINED
*Internal os IS 'CLOSED' (Kaplan has a typo here..u may cross-chk this in williams obs or emedicine http://www.emedicine.com/med/topic3310.htm )
---Manage: Observe and serial B-hCG
Regarding the different types of abortions, they represent findings along a continum from the beginning of losing the pregnancy to complete expulsion of the products of conception.
Complete Abortion is the FINAL one... In this one there are NO Products of Conception retained (we agree on that)... And so therefore, the cervical os must be DILATED (how else would the products of conception be expelled otherwise?)... I understand it says CLOSED in emedicine, and I have read dilated vs. closed from other sources as well... I think it may depend on how long after the abortion occured. If you check it immediately afterwards, it is probably open (dilated), but if the woman comes in a few days or weeks afterwards, it will be closed by then.
See this site:
http://www.merck.com/mmpe/sec18/ch263/ch263l.html
Go to table 2 which says for Complete Abortion cervical os can be either DILATED OR CLOSED.
Just my thoughts... Let me know what you think... And thanks again for bringing up this point.
Edited by DrVirgo on 02/04/07 - 06:48 PM
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| DrVirgo
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Mg Toxicity Triad
*Preterm labor tocolysis
( this is not a sign of toxicity, it is one of the benefits of Mg in preterm labor)
So the triad is :-
* Disappearence of DTR( pateller reflex diminshed is the first sign at levels < or = to 10mg/dl of Mg) and muscle weakness
*Pulmonary edema
*Resp depression at levels > 10 mg/dl and resp.arrest at levels > 12 mg/dl of Mg.
[/quote]
You are right: Mg is used to prevent pre-term labor, so that's not a toxicity effect... I'll change it in the original post for everyone.
Where did you read about the effect of Mg on DTR's? And why is it at levels LESS THAN 10? Did you mean more than 10???
I would like to read more about that. Thanks.
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| Aashi
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Dr.Virgo, I did my oB-gyne from williams obstetrics and emedicine is right..A q on complete abortion typically tells u that a pregnant lady comes to the ER say 13 -14 GA, who had hx of sever abd cramping for hrs or days and heavy bleeding and who had passed out POC, and now pain and bleeding seems to be SUBSIDED and when u a do a U/S there uterus is empty and in P/EX the os is CLOSED. In threatened abortion--> OS IS CLOSED + PT c/o bleeding,but the pt will have a viable pregnancy on U/S, and in MISSED abortion--> there is A NON-VIABLE FETUS on U/S and + a closed cervix, with no apparent bleeding and hence the name 'MISSED abortion'..and ofcourse the OS might be still open if u examine her within mins after she passes all her POC( os closes soon after all the POC is passed, not in days), and u/s shows an empty uterus + hx of clinically recorded pregnancy, and yes the answer is still complete abortion..but more commonly the q will say OS CLOSED( coz this is the MC presentation)
And ur q abt Mg TOXICITY--> the therapeutic level of Mg is b/w 4- 7 mEq/l anythin more that ( Say 9- 10 meq/l) effects the DTR FIRST specially the patellar, so u have to monitor the reflexes in a pt who is on Mg , the rest of s/s depends on the level of Mg In the blood , which i had mentioned above..
And the source to the above info is WILLIAMS OBSTETRICS( 21st edition)
GL
Edited by Aashi on 02/04/07 - 06:03 PM
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| DrVirgo
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I have made the corrections in the original posts... Thanks again Aashi for being to vigilant and bringing up those points.
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| Aashi
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Ur welcome Dr.Virgo
Will contribute to this thread, if somthin interesting comes up..
GL
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| DrVirgo
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Hypertension and Pregnancy:
Transient HTN Triad:
*Gestation > 20 weeks
*Non-sustained HTN
*No proteinuria
Chronic HTN
*Gestation <20 weeks
*Sustained HTN >140/90
*+/- Proteinuria
MILD Preeclampsia Triad
*Gestation > 20 weeks
*Sustained HTN (>140/90)
*Proteinuria (> 300 mg/24hr)
SEVERE Preeclampsia
*Sustained BP >160/110
*Proteinuria on dipstick of 3-4 or >/= 5g on a 24 hr urine collection
*Evidence of maternal jeopardy (HA, visual changes, epigastric pain, pl count <100,000/ml, elevated live enzymes, pulmonary edema, oliguria or cyanosis.
* +/- Edema
HELLP
-Hemolysis, elevated LFTs, Low Platelets
-Rx: MgSO4 and deliver
Eclampsia:
*Gestation >20 Weeks
*BP >240/90
* Proteinuria
*Unexpected convulsions
Chronic HTN and Superimposed Preeclampsia:
*Chronic HTN
*Worsening BP
*Worsening Proteinuria
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| DrVirgo
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Shoulder Dystocia:
-As birth weight increases risk for SD increases.
MC risk factor --> Maternal DM (DM moms have big babies -macrosomia)
*2nd Stage of Labor
*Head has delivered
*No Further deliver of baby.
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| DrVirgo
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POSTPARTUM ISSUES...
UTERINE ATONY
*PP Hemorrhage
*delivered twins (or any other cause of overdistended uterus
*Uterus feels DOUGHY/BOGGY/SOFT/
-->Tr: Massage, and uteroTONIC agents: oxytocin, methylERGONovine, or Carboprost
PERINEAL LACERATIONS
*PP Hemorrhage
*Uncontrolled Vaginal Delivery/Difficult delivery/Operational vag. delivery
*Uterus feels FIRM
---> Tr: Surgical
RETAINED PLACENTA:
*PP Hemorrhage
*PP vessels extend over membrane edge
*Uterus feels FIRM
-->Tr: Manual removal
DIC
*PP Hemorrhage
*Abruuptio Placenta-MC Risk factor. or preeclampsia, AF embolism,or fetal demise
*Blood oozing from IV site
--> Tr. remove placental tissues, ICU, adn blood replacement.
UTERINE INVERSION
*PP Hemorrhage
*BEFFY bleeding vaginal mass
*CANNOT FEEL UTERUS
--> Tr. Elevate vag. fornices, lift uterus up and give IV Oxytocin
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| DrVirgo
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Adenomyosis -endometrial glands and stroma WITHIN the myometrium.
*Enlarged NON-Pregnant Uterus
*Most Asymp/IF symp: Dysmenorrhea
*Menorrhagia
-->Tr: LNG or IUS, or surgery
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| DrVirgo
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ECTOPIC PREGNANCY:
*Unilateral Lower abdominal pain-may be hemodyn. unstable
*First Amenorrhea (missed period for # of weeks)
*Then Vaginal bleed
SPECIFIC Criteria: No intrauterine gestational sac and the B-hCG > 1,500mIU
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