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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
Abruptio Placenta Triad:
*MCC of Late trimester PAINFUL bleeding
*Normal placental implantation
*DIC
Placenta Previa Triad:
*Late Trimester bleeding
*Low Segment placental implantation
*NO PAIN
Vasa Previa Triad:
*ROM
*Vaginal bleeding
*Fetal bradycardia
Uterine Rupture Triad:
*Late Trimester Bleeding
*Loss of Fetal Heart tracing
*Inability to identify uterine contractions
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)
---Manage: Observe and serial B-hCG
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
Chorioamnionitis
*Maternal fever
*Uterine tenderness
*PROM in the absence of URI or UTI
PRETERM LABOR TRIAD
*20-36 week prego.
*> 3 UC's in 30 min
*Dilated 2 or more cm or changing
Premature contractions
IF:
*20-36 week preg.
*> 3 UC's in 30 min
***Dilated LESS THAN 2 cm or NOT changing
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
.
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
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 <1
00,000/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
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.
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
Adenomyosis -endometrial glands and stroma WITHIN the myometrium.
*Enlarged NON-Pregnant Uterus
*Most Asymp/IF symp: Dysmenorrhea
*Menorrhagia
-->Tr: surgery