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Flashcards by moradnasseri, updated more than 1 year ago
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Created by Jaimie Shah
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Copied by moradnasseri
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| Question | Answer |
| when is gestational sac present on US | 4-5 weeks with HCG>1500 |
| when is fetal heart motion seen | 5-6wks on US |
| fetal heart sounds heard with doppler | US at 8-10wks |
| fetal movements felt when | after 20wks gestation |
| review first tirmester screening chart | pg 378 and 379 |
| review second trimester screening table | pg 380 |
| inc MS-AFP | NTD, ventral wall def, twin preg, placental bleed,renal dz, sacrococcygeal teratoma |
| dec in MS-AFP | trisomy 21 and 18 |
| dec MS-AFP, dec estriol, inc BHCG | trisomy 21 |
| trisomy 18 | MS AFP, Estriol and B HCG all low |
| if dating is correct and MS AFP is elevated what next? | do amiocentesis for acholinesterase activity and if high then spp of NTD |
| if dating correct and MSAFP low what to do next? | do amiocentesis for karyotyping |
| review routine third trimester testing | p. 381 |
| Antiemetics safe in pregnancy | Doxylamine, Metoclopramide, Ondansetron, Promethazine, Pryidoxine |
| cause of bleeding after 20wks gestation | abruption (painful), placenta previa (painless), Vasa previa (painless), lower genital tract laceration or uterine rupture (painful). |
| late decels and bradycardia are seen in fetal compromise when? | the fastest in bleed with vasa previa because the blood comes from fetal circulation first |
| when do you give Rhogam in negative mothers | 28 wks, within 72hrs of delivery, after miscarriage and abortion, during amiocentesis or CVS adn with heavy vaginal bleed |
| never perform an exam on preg woman with late preg bleed till you do US to r/o placenta previa | true |
| inital mgmt steps for late preg bleed | get vitals, fetal monitor, IVFs, CBC, DIC panel, type and cross, US, transfuse, place foley, vaginal exam after US, delivery if more than 36wks |
| clue to dx of abruption if the bleeding is concelaed | scan amount of bleeding with constant abd pain. DIC is a feared complication and can be reduced with amniotomy and induction of labor |
| vasa previa | when fetal vessels lye past the cervix so when ROM occurs the fetus loses bloods as it's vessels are ruptured |
| so if mother in labor and no ROM do an US... | if you see the vessels cross the cervix do not Rupture membranes because you will rupture the vessels. |
| placenta accreta<increta<percreta | listed in increasing depth of invasion of the uterine wall |
| signs of urterine rupture | loss of electronic fetal heart rate, uterine contractions, and recession of fetal head. |
| review table of late trimester bleeding causes | pg 385 |
| tx of GBS | intrapartum Pen G IV, or IV cefazolin, clinda, or erythromycin; GBS causes PNA/sepsis in first hours/days and after first week menegitis but this is hosp acquired no from the mother |
| when do we give abx for GBS | GBS + urine, cervical, vag cx, preterm del, ROM>18hrs, maternal fever, prior baby with GBS sepsis |
| when do you not give abx for GBS | planned c section and no ROM but + culture; cx + in past but negative now |
| congenital toxo triade | chorioretinitis, IC calcifications, hydrocephalus |
| RF or toxo | handle cat feces/litter, drink raw milk or eating raw meat |
| prevent toxo | avoid exposure and spiramycin to prevent vertical transmission |
| dx of toxo | check IGM and if IGG avidity low then recent infection so she needs pyrimethamine and sulfadiazine |
| biggest risk factor for varicella passing to the infant from mother | if mother has rash 5 days before delivery and 2 days after delivery |
| s/s of neonatal varicella infection | zigzag skin lesion, limb hypoplasia, microcephaly, micophthalmia, chorioretinitis, cataracts. |
| prevent varicella to the neonate | vaccinate non preg women, and VZVIg or antibody within 10d of exposure (attenuates effects doens't prevent) |
| maternal varicella treatement | Varicella ab to mother and neonate |
| congenital varicella | Ig and acyclovir to the neonate |
| congenital rubella | adverse effects occur with primary infection in the first 10wks of gestation |
| S/S of congenital rubella | cataracts, MR, hepatosplenomegaly, low plts, bluberry muffin rash |
| prevention of congenital rubella | screen in first trimester, avoidance, immunize after delivery, no post exp ppx |
| CMV is the most common cause of what in the US | SN hearing loss |
| about 10% of infants have symptomatic CMV at birth, S/S? | IUGR, preme, microcephaly, jaundice, petechiae, hepatospelnomegaly, Periventriccular calcifications, chorioretinitis, and PNA |
| in mother check IGG and IGM for CMV and check viral culture from urine or body fluids in first 2wks of life and PCR | true |
| tx CMV | ganciclovir can prevent shedding and hearing loss; but not a cure of infection; IG can help in reducing spread from exp preg woman |
| only two active disease warrant C-section | HIV and HSV |
| neonatal HSV infection | 50%mortality, and if live have meningoencephalitis, MR, PNA, hepatosplenomegaly, jaundice, petechiae |
| other prevention of HSV | avoid intercouse if partner has it, avoid oral sex if partner has oral lesions and avoid kissing neonate if anyone has oral lesions |
| acyclovir is treatment in primary infection in patient | true |
| prevent passing of HIV to neonate | elective C section for low CD4 and viral load>1000; false positive neontate at first; triple therapy must include ZDZ, no breast feed, no AROM |
| HIV prevention in neonate | ZDZ based ART for 6wks after delivery, PCP ppx and continue for 6wks past ART therapy |
| there is no immunity from syphillus infection and reinfection can always happen | true |
| can pass to baby if primary or secondary and much lower with tertiary or latent syphilis | true |
| syphilis acquired in first trimester s/s | nonimmune hydrops fetalis, maculopaupular rash, anemia, low plts, hepatosplenomegaly, edematout placenta, perinatal mortality 50% |
| late acq syphilis s/s appear at 2 yrs of age | hutchinson teeth, mulberry molars, saddle nose, saber shins, deafness |
| c section prevents spread of congenital syphilis | false |
| dx of syphilis | VDRL or RPR screen and confirm with FTA-ABS or MHA-TP; screen neg in primary syphilis so bx ulcer with darkfield |
| tx syphilis in mothers | IM benzathine PCN x1 |
| how do neonates contract HBV | from primary infection in 3rd trimester or ingest genital secretions; 80% will develop chronic hep unlike adults where only 10% contract chronic hep |
| if mothers are e antigen positve what percent risk is there for passage..and if not what is the percent to pass hep to the baby? | 80%, if not then 10% passage risk |
| prevent spread to neonate of hep B | not c section, avoid invasive procedures (amiocetesis), can breastfeed after baby gets HBIG; to mother give immunization if HBsAg neg and post exp ppx with antibodies to hep B (Ig) |
| tx of hep in infant | immunize and HBIG; chronic treat with interferon or lamivudine |
| review breakdown of HTN in pregnancy | pg 394 and 395 |
| never give ACE i of thiazides in preg to control BP | true |
| HELLP can occur... | in the third trimester and pospartum as well (2days after delivery) |
| risk factor of HELLP different from preeclampsia | whites, multigravids and women of older maternal age |
| tx of HELLP | immediate del, IV decadron before and after del if plt<100,000 till >100,000; transfuse plt is<20,000 or <50,000 and to get C section; Mag even if BP nl to prevent seizures; steroids for fetal lung development may be needed. |
| complications of HELLP | DIC, abruption, fetal demise, ascites, hepatic rupture |
| never use an ACE I or ARB during pregnancy | true |
| loop diuretics, nitrates, BB may be continued | true |
| digoxin can be used to control HF symps in pregnancy but it does not effect outcome | true |
| use rate control in preg patients; do not give amiodarone or coumadin | true |
| Endocarditis ppx is the same as nonpreg pts, don't need ppx for actual delivery or c section | true |
| regurgitant lesions are fine in preg but stenotic lesions are exacerbated and increase materal/fetal mortality | true |
| mital stenosis in preg has increased risk pulm edema and afib | true |
| PE is leading cause of maternal death in US; 50% who get it have a hypercoagulable disease...when do we give DVT/PE ppx | afib with heart disease (but not lone afib), Antiphospholipid syndrome, HF with EF<30%, Eisenmenger syndrome |
| in patient with prior history or reason of anticoagulation what do we give? | ppx LMWH; intrapartum unfractioned heparin, and coumadin 6wks postpartum |
| hyperthyroid in preg causes | FGR and still birth |
| hypothyroid in preg causes | intellectual def and miscarriage |
| preg does not effect S/S of hyper or hypothyroidism and normal lab values of free T4/TSH | true |
| increase thyroid hormone dose in hypothyroid in preg by 25-30% | true |
| drug of choice for hypothyroid in preg | synthroid |
| symptomatic hyperthyroid use | BB not radioactive iodine |
| tx grave's dz in preg | PTU may cause hypothroid in fetus; congenital graves can be masked for until 7-10d after birth |
| maternal TSIG can cross the placenta and cause | fetal tachy, FGR, goiter |
| target BS in preg | FBS<90 and <120 1 hr after a meal |
| Diabetes mgmt in preg | start with lifestyle changes, add insulin if no control, avoid oral agents when breast feeding can cause fetal hypoglycemia |
| routine monitoring in preg patients | A1c each trimester if elevated in first trimester: US 18-20wks, fetal echo 22-24wks. triple screen 16-18wks, monthly US, monthly BMP, wkly NST/AFI at 32wks |
| GDM post partum care | check 2 hr 75g OGTT at 6-12wks postpartum; 35% develop over DM 5-10yrs after delivery |
| rare congenital abn in over DM mother | caudal regression syndrome. |
| A1C>8.5 in first trimester assoc with what | congenital malformations (NTD); not true of GDM since hyperglycemia is not seen in the first trimester |
| labor mgmt in diabetic patient | target del at 40wks, induce if <4500g (check L/S>2.5), sch C section if >4500g; use insulin drip intrapartum and off after del. use ISS |
| fetal problems with diabetic mother | hypoglycemia, hypocalcemia, polycythmia, hyper bili, RDS |
| european preg patient with twins, has intractable puritis worse at night on palms and soles and elevated Bili | intrahepatic cholestasis in preg (tx is ursodeoxycholic acid) |
| acute fatty liver in pregnancy | due to fetus abn fat metabolism so you see HTN, proteinuria, edema, elevated LFTs, low BS, inc Bili, DIC, inc ammonia (tx with IVF and delivery) |
| tx asx bacturia in preg | macrobid or amoxicillin or cefalexin |
| tx of pyelonephritis in preg | IVF and IV cephalosporin or gentamicin and tocolysis |
| when can D and C be done for abortion | before 13wks gestation |
| when can we use misoprostol for abortion | used in the first 63 days of amenorrhea |
| second trimester methods of abortion | D and E and partial birth |
| spontaneous birth occurs when <20wks adn <500g fetus | true |
| fetal demise | in utero death after 20wks, loss of fetal movements |
| half of preg complicated by threatened abortion go to term | true, you need a speculum exam and check for doppler for fetal cardiac activity |
| pregnant woman with bleeding, painful cramps and dilated cervix on exam | inevitable abortion |
| loss of early preg but no S/S, and no cardiac activity on US | missed abortion |
| mgmt of incomplete abortion | US confirms debris and you need to do a D/C |
| mgmt of complete abortion | no debris on US check serial B HCG to be sure an ectopic was not missed |
| what is a complication that needs to be ruled out with fetal demise | check coags to r/o DIC; if it's there then the baby needs to be delivered immediately |
| tx of ectopic preg | if ruptured surgery if not can use MTX, give rhogam to RH neg woman, f/u BHCG to ensure complete removal of fetus |
| when do you use MTX in ectopic | if <3.5cm, no fetal heart sounds, bHCG<6000, no hx of folic supplementation |
| what do you need to r/o before perform cerclage for cervical insuff | r/o chorioaminionitis |
| tx of cervical insuff | elective cerclage at 13-16wks with >3 unexplained midterm preg losses; remove it at 36-37wks gestation |
| short cervix on exam at 16 wks, but no symps or dilated cervix what do we do? | monitor with US if short at 20wks |
| define IUGR | EFW is <5-10% of gest age or <2500g; accurate dating needed and if <20wks and don't know age check US (later US not accurate) |
| review IUGR chart | p. 406 |
| define macrosomia | EFW>90-95% of gestation age or birth wgt 4000-4500g |
| Diagnose PROM or ROM | sterile vaginal exam seen posterior fornix pooling, nitrazine positive, ferning positive, US oligohydraminos |
| clinical dx of Chorioamnionitis | maternal fever and uterine tenderness, confirmed ROM, abs of URI/UTI |
| what to do with PROM<24 wks gestation | manage at home on bed rest |
| PROM mgmt at 24-33weeks | hospitalize give IM betamethasone, cervical cx, ppx amoxicillin and erythromycin for 7 days |
| PROM mgmt at 34wks | initiate delivery |
| review stage of labor | p. 409 |
| mgmt umbilical cord prolapse | don't replace cord, place mom in knee to chest, elevate presenting part of cord and add tertbutaline to decrase force of contractions, preform immediate C section |
| changes in FHR on monitor are related to the following | uterine hyperstim, fetal head compression, umbilical cord compression, placental insuff |
| nl FHR | 110-160bpm |
| FHR tachy/ brady due to the following | tachy (meds- beta agonist, terbutaline, ritodrine); brady (BB or local anesthetics) |
| Acceleration on monitor | abrupt increase in FHR<2min and unrelated to contractions (reassure) |
| Early deceleration on monitor | gradual dec in FHR begin and end with contraction due to fetal head compression |
| variable decleration on monitor | abrupt dec in FHR unrelated to cxn; due to umbilical cord compression; indicate fetal acidosis (not reassure) |
| late deceleration on monitor | gradual dec in FHR come delayed in relation to CXN; uteroplacental insuff, indicate fetal acidosis (bad) |
| variability on monitor | 6-25BPM between and is reassuring |
| stepwise approach to nonreassuring fetal trace | check strip, evaluate for drug causes; d/c meds, give IV fluid, high flow O2, put patient on her left, vaginal exam r/o prolapsed cord, scalp stim; prep for delivery if no improvement; if unclear get fetal scalp PH (need dilated cervix and ROM) |
| optimum time for external version | for 37wks and success is 60-70% |
| breast feeding buys you 3 months off birthcontrol | true |
| Diaphragm and IUD should no be placed for 6 wk after del | true |
| combined birth control | not used for 3wks post del to prevent dvt; not used if breast feeding due to decreased lactation |
| progesterone only can be used right after del | true |
| review post partum fever chart | p. 414 |
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