OBY Study Exam 2 Notes PDF

**Violence Against Women (2 Questions)** 1. **Signs and Symptoms** - Physical: Bruises, fractures, burns, head injuries - Emotional: Anxiety, depression, PTSD, low self-esteem - Pregnancy-related: Preterm labor, low birth weight, frequent UTIs/STIs 2. **Appropriate S...

**Violence Against Women (2 Questions)** 1. **Signs and Symptoms** - Physical: Bruises, fractures, burns, head injuries - Emotional: Anxiety, depression, PTSD, low self-esteem - Pregnancy-related: Preterm labor, low birth weight, frequent UTIs/STIs 2. **Appropriate Screening Techniques** - Use trauma-informed care approach - Routine screening at prenatal visits (ask in private) - Tools: HITS (Hurt, Insult, Threaten, Scream), Abuse Assessment Screen (AAS) - Documentation of injuries and statements **Chronic Conditions (8 Questions)** **Diabetes and Testing** - **Screening:** A1C, fasting blood glucose, oral glucose tolerance test (OGTT) - **Complications:** Macrosomia, birth trauma, neonatal hypoglycemia, stillbirth - **Management:** Insulin use, glucose monitoring, lifestyle changes **Gestational Diabetes and Diet** - **Risk factors:** Obesity, PCOS, family history of diabetes - **Screening:** 1-hour glucose challenge test at 24--28 weeks; if positive, 3-hour OGTT - **Dietary management:** Low glycemic index foods, carbohydrate counting, high fiber intake - **Complications:** Fetal macrosomia, neonatal hypoglycemia, preeclampsia risk **Infections (Rubella, CMV, GBS, HIV)** - **Rubella:** Congenital rubella syndrome (deafness, heart defects, cataracts) → Prevent with MMR vaccine postpartum - **CMV:** No vaccine; causes microcephaly, hepatosplenomegaly, developmental delays - **GBS:** Tested at 35--37 weeks; treated with intrapartum IV penicillin - **HIV:** Avoid breastfeeding, ART therapy, C-section if viral load high **Cardiac Conditions in Pregnancy** - **Pre-existing:** Congenital heart disease, mitral valve prolapse, arrhythmias - **Peripartum cardiomyopathy:** Heart failure in late pregnancy/postpartum - **Management:** Frequent monitoring, avoid excessive weight gain, limit strenuous activity **Anemia in Pregnancy** - **Types:** Iron-deficiency (most common), folic acid deficiency, sickle cell - **Symptoms:** Fatigue, pallor, dizziness, SOB - **Treatment:** Iron supplements (with vitamin C), folic acid **Pregnancy-Related Complications (20 Questions)** **High-Risk Pregnancy Risk Factors** - **Maternal factors:** Advanced maternal age, obesity, diabetes, HTN, substance use - **Fetal factors:** IUGR, multiple gestation, genetic abnormalities **Miscarriage (1st and 2nd Trimester)** - **Threatened vs. Inevitable vs. Incomplete vs. Complete** - **Management:** Expectant, medical (misoprostol), surgical (D&C) **Molar Pregnancy** - **Hydatidiform mole (benign tumor of trophoblasts)** - **Signs:** Rapid uterine growth, high hCG, absence of fetal heart tones, grape-like vesicles on ultrasound - **Management:** Suction curettage, serial hCG monitoring **Ectopic Pregnancy** - **Implantation outside uterus (usually fallopian tube)** - **Signs:** Unilateral pelvic pain, vaginal bleeding, referred shoulder pain - **Treatment:** Methotrexate (if stable), surgery (if ruptured) **Hyperemesis Gravidarum** - **Severe N/V leading to dehydration, weight loss, electrolyte imbalances** - **Management:** IV fluids, antiemetics (ondansetron, promethazine), small frequent meals **Cervical Insufficiency/Cerclage** - **Painless cervical dilation leading to preterm birth** - **Treatment:** Cerclage placement (removed before labor) **Placenta Previa** - **Placenta covering cervix → painless bright red bleeding** - **Management:** No vaginal exams, bed rest, C-section delivery if complete previa **Placental Abruption** - **Premature separation of placenta → painful bleeding, firm abdomen** - **Risk factors:** HTN, trauma, cocaine use, previous abruption - **Management:** Emergency C-section if severe **Gestational HTN, Pre-Eclampsia, Eclampsia, HELLP** - **Gestational HTN:** BP \>140/90 after 20 weeks, no proteinuria - **Pre-eclampsia:** HTN + proteinuria ± signs of organ dysfunction (headache, vision changes, epigastric pain) - **Eclampsia:** Pre-eclampsia + seizures → Magnesium sulfate for seizure prevention - **HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets):** RUQ pain, liver failure, DIC risk **ABO/Rh Incompatibility** - **Rh-negative mom + Rh-positive baby → risk of hemolytic disease in newborn** - **Management:** Rhogam at 28 weeks and postpartum if baby is Rh-positive **Oligohydramnios/Polyhydramnios** - **Oligohydramnios:** Low amniotic fluid → cord compression, pulmonary hypoplasia - **Polyhydramnios:** Excess amniotic fluid → maternal diabetes, fetal anomalies **Labor Complications (15 Questions)** **Cord Prolapse** - **Cord slips out before baby → emergency!** - **Intervention:** Position mom in knee-chest, manually lift presenting part off cord **Shoulder Dystocia** - **Baby's shoulder stuck under pubic bone** - **Management:** McRoberts maneuver, suprapubic pressure **Induction/Augmentation** - **Methods:** Pitocin, cervical ripening agents (misoprostol, dinoprostone) - **Risks:** Uterine tachysystole, fetal distress **Preterm Labor/Postterm Delivery** - **Preterm labor:** Contractions before 37 weeks → treat with tocolytics (nifedipine, terbutaline) - **Postterm delivery (\>42 weeks):** Risk of macrosomia, meconium aspiration **Forceps/Vacuum** - **Indications:** Prolonged second stage, fetal distress - **Complications:** Facial nerve injury (forceps), cephalohematoma (vacuum) **Amnioinfusion** - **Used for:** Cord compression (variable decels), thick meconium - **Risks:** Uterine overdistension **Amniotic Fluid Embolism** - **Signs:** Sudden respiratory distress, hypotension, DIC - **Management:** Oxygen, fluids, CPR if needed **Vaginal Birth After Cesarean (VBAC)** - **Risk:** Uterine rupture - **Contraindication:** Classical (vertical) uterine incision **Precipitous Delivery** - **Rapid labor \6 indicates favorable cervix** **Uterine Rupture** - **Complete tear of uterine wall → fetal distress, maternal shock** - **Emergency C-section required** **Hypotonic/Hypertonic Labor** - **Hypotonic:** Weak contractions → oxytocin augmentation - **Hypertonic:** Frequent, painful contractions → risk of fetal distress, uterine rupture