Ectopic pregnancy

Poling of blood and irriation can cayse adnexal tenderness, cervical motion
tenderness, diffuse abdominal pain, shoulder pain and urge to poop from
blood in porterior cul de sac
Diagnosis is based on B hCG and transvaginainal US wich shows empty
uterus and adnexal mass. In rupture there is free intraperitoneal fluid.
Lower abdominal discomfort, constipation and nausea are normal preganancy
(no mass or motion tenderness)

Vasa Previa will show fetal tachy followed by braducardia and then sinusoidal
pattern. Gold Standard are abdominal and tranvaginal Doppler US. Do C section
prior to labor.
Polyhydroaminos causes amternal symptoms due to compression of lungs,
abdominal oragans and vessles. There may be edema and difficulty breathing
Screening for syphilis, hepatits B and HIV happens in all women in first visit,
regardless of RF
Antepartum fetal survelliance is done in high risk pregnancies
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Hypertension
Diabetes
Post term
Isoimmunization
FGR
Goal- prevent fetal demise
Tests assess- Fetal hypoxemia and academia
NST has high NPV and is done weekly

Risk factors for spontaneous abortions

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Smoking
Advanced age
Previous abortion
Causes chromosomal or structural problems

Abnormal 2nd trimester quadruple screen is confirmed with amniocentesis (16-20w),

but first do US to assess fluid levels and GA
CVS is early screening for people who desire fetal karyotyping as early as 10-13 w
Cordocentesis (percutaneous umblical blood sampling)
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Fetal blood gas analysis

Karyotyping
Blood culture
Usually done when others are inconclusive

PAPP A is a glycoprotein made my trophoblast

Anorexic moms

Preterm babies
Small for GA (IUGR)
Miscarriages
Hyperemesis gravidarum
C sec
Postpartum depression (not psychosis)

Findings in anorexia
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Osteoporosis
Elvated cholesterol and carotene
Cardiac arrhythmias (QT)
Euthyroid sick syndrome
HPA dysfunction leading to low estrogen and amenhorrea
Hyponaterimia

IUFD is confirmed with real time ultrasound to demonstrate no cardiac activity or

fetal movement
Etiology of IUFD- autopsy of the fetus and placenta should be performed in all
cases of still birth
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Hypertensive disorders
Diabetes
Placental and cord complications
Antiphospholipid syndrome
Congenital anomalies
Fetal TORCH infections and listeriosis
50 % are unknown

HELLP- centrilobular necrosis, hematoma formation and thrombi in portal

system, which leads to distention LIVER CAPSULE Glissons. ALP is normally
elevated in pregnancy.
AFLP and HELLp may look alike, but AFLP ae more likely to have additional
extrahepatic complications, such as, leukocytosis, hypoglycemia, acute kidney
injury. Severe HTN is more likely in HELLP
Rupture of liver adenoma leads to intraabdominal bleeding with peritonitis
(tenderness and rebound) and hypotension.
Cervical incompetence- Transvaginal ultrasound is gold standard. It is used to
look at the funneling of the cervix or shortening of the cervical length. It should
be more than 25mm at 24 weeks. A cervical length below 10 th percentile for GA
is short cervix ie less than 25mm at 23-28 weeks
RF for placenta previa
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Multiparity
Advanced age
Prior C section
Smoking
Previous uterine surgery

6- Previous placanta previa

7- Mulitple gestation
For patients who need rubella, dont get pregnant for 28 days, before it was 3
months. If they do, routine prenatal care is done, as vaccine isnt as harmful
Increases MSAFP
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NTDS
Ventral wall defects
Multiple gestations
Fetal congenital nephrosis
Benign obstructive uropathy

An elevated MSAFP is followed by careful ultrasound for fetal anatomy.

Progestrone is used to prevent preterm labor in a patient with history
Early neonatal care
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Intital physical assessment

Removal airway secretions
Drying and keeping it warm
Early preventive measures ( gonocococal eye infection prevention and
vitamin K)

Placental abruption do vaginal delivery if fetus and mom are stable

Low grade fever and leukocytosis are common in the first 24 hours of the
postpartum. Intrapartum and postpartum chills are common too.
Abruption placenta is due to premature separation of placenta from the uterus and
hemorrhage in decidua basalis. Fetal heart rate is initially reassuring but then
detoriates. Diagnosis is clinical.
Back pain- main is due to increase in lumbar lordosis. Relaxation of the ligaments of
sacroiliac and oter joints of pelvis due to hormones may also contribute to back pain
If a woman has fever higher than 38C or 100.4 F outsid of the first 24 hours, think
puerperal infection. RF are
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PROM (24 hrs)

Prolonged labor (12hrs)
C section
Use of intrauterine catheters
Fetal scalp electrodes

Endometritis is asoociated with fever, uterine tenderness, leukocytosis and foul

smelling lochia. It is the MCC of puerperal fever on 2 nd and 3rd days. Polymicrobial
infection. Give IV gentamicin and clindamycin
In false labor, contractions are felt in the lower abdomen, are irregular, the interval
doesnt shorten and intensity doesnt increase. It may eventually become rhythmic,

and occur every 10-20 mins and increase in intensity, but they wont have
progressive cervical changes or be relieved by sedation.
True labor has contractions that occur at regular intervals with a progressively
shortening interval and increasing intensity. The pain of true labor is in the back and
upper abdomen and is not relieved by sedation. There are cervical changes.
For false labor-reassure
In patients who are hemodynamically unstable- do ABC- MCC are previa and
abruption
ALL EXCEPT MARKED