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Flashcards

Step 3 - Obstetrics

Jaimie Shah Step 3 cards Inglês 4,0Avaliação média 4,0 de 5 (1 avaliação) 137 flashcards

Flashcards do conjunto (137)

  1. 1when is gestational sac present on US4-5 weeks with HCG>1500
  2. 2when is fetal heart motion seen5-6wks on US
  3. 3fetal heart sounds heard with dopplerUS at 8-10wks
  4. 4fetal movements felt whenafter 20wks gestation
  5. 5review first tirmester screening chartpg 378 and 379
  6. 6review second trimester screening tablepg 380
  7. 7inc MS-AFPNTD, ventral wall def, twin preg, placental bleed,renal dz, sacrococcygeal teratoma
  8. 8dec in MS-AFPtrisomy 21 and 18
  9. 9dec MS-AFP, dec estriol, inc BHCGtrisomy 21
  10. 10trisomy 18MS AFP, Estriol and B HCG all low
  11. 11if dating is correct and MS AFP is elevated what next?do amiocentesis for acholinesterase activity and if high then spp of NTD
  12. 12if dating correct and MSAFP low what to do next?do amiocentesis for karyotyping
  13. 13review routine third trimester testingp. 381
  14. 14Antiemetics safe in pregnancyDoxylamine, Metoclopramide, Ondansetron, Promethazine, Pryidoxine
  15. 15cause of bleeding after 20wks gestationabruption (painful), placenta previa (painless), Vasa previa (painless), lower genital tract laceration or uterine rupture (painful).
  16. 16late decels and bradycardia are seen in fetal compromise when?the fastest in bleed with vasa previa because the blood comes from fetal circulation first
  17. 17when do you give Rhogam in negative mothers28 wks, within 72hrs of delivery, after miscarriage and abortion, during amiocentesis or CVS adn with heavy vaginal bleed
  18. 18never perform an exam on preg woman with late preg bleed till you do US to r/o placenta previatrue
  19. 19inital mgmt steps for late preg bleedget vitals, fetal monitor, IVFs, CBC, DIC panel, type and cross, US, transfuse, place foley, vaginal exam after US, delivery if more than 36wks
  20. 20clue to dx of abruption if the bleeding is concelaedscan amount of bleeding with constant abd pain. DIC is a feared complication and can be reduced with amniotomy and induction of labor
  21. 21vasa previawhen fetal vessels lye past the cervix so when ROM occurs the fetus loses bloods as it's vessels are ruptured
  22. 22so 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.
  23. 23placenta accretalisted in increasing depth of invasion of the uterine wall
  24. 24signs of urterine ruptureloss of electronic fetal heart rate, uterine contractions, and recession of fetal head.
  25. 25review table of late trimester bleeding causespg 385
  26. 26tx of GBSintrapartum 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
  27. 27when do we give abx for GBSGBS + urine, cervical, vag cx, preterm del, ROM>18hrs, maternal fever, prior baby with GBS sepsis
  28. 28when do you not give abx for GBSplanned c section and no ROM but + culture; cx + in past but negative now
  29. 29congenital toxo triadechorioretinitis, IC calcifications, hydrocephalus
  30. 30RF or toxohandle cat feces/litter, drink raw milk or eating raw meat
  31. 31prevent toxoavoid exposure and spiramycin to prevent vertical transmission
  32. 32dx of toxocheck IGM and if IGG avidity low then recent infection so she needs pyrimethamine and sulfadiazine
  33. 33biggest risk factor for varicella passing to the infant from motherif mother has rash 5 days before delivery and 2 days after delivery
  34. 34s/s of neonatal varicella infectionzigzag skin lesion, limb hypoplasia, microcephaly, micophthalmia, chorioretinitis, cataracts.
  35. 35prevent varicella to the neonatevaccinate non preg women, and VZVIg or antibody within 10d of exposure (attenuates effects doens't prevent)
  36. 36maternal varicella treatementVaricella ab to mother and neonate
  37. 37congenital varicellaIg and acyclovir to the neonate
  38. 38congenital rubellaadverse effects occur with primary infection in the first 10wks of gestation
  39. 39S/S of congenital rubellacataracts, MR, hepatosplenomegaly, low plts, bluberry muffin rash
  40. 40prevention of congenital rubellascreen in first trimester, avoidance, immunize after delivery, no post exp ppx
  41. 41CMV is the most common cause of what in the USSN hearing loss
  42. 42about 10% of infants have symptomatic CMV at birth, S/S?IUGR, preme, microcephaly, jaundice, petechiae, hepatospelnomegaly, Periventriccular calcifications, chorioretinitis, and PNA
  43. 43in mother check IGG and IGM for CMV and check viral culture from urine or body fluids in first 2wks of life and PCRtrue
  44. 44tx CMVganciclovir can prevent shedding and hearing loss; but not a cure of infection; IG can help in reducing spread from exp preg woman
  45. 45only two active disease warrant C-sectionHIV and HSV
  46. 46neonatal HSV infection50%mortality, and if live have meningoencephalitis, MR, PNA, hepatosplenomegaly, jaundice, petechiae
  47. 47other prevention of HSVavoid intercouse if partner has it, avoid oral sex if partner has oral lesions and avoid kissing neonate if anyone has oral lesions
  48. 48acyclovir is treatment in primary infection in patienttrue
  49. 49prevent passing of HIV to neonateelective C section for low CD4 and viral load>1000; false positive neontate at first; triple therapy must include ZDZ, no breast feed, no AROM
  50. 50HIV prevention in neonateZDZ based ART for 6wks after delivery, PCP ppx and continue for 6wks past ART therapy
  51. 51there is no immunity from syphillus infection and reinfection can always happentrue
  52. 52can pass to baby if primary or secondary and much lower with tertiary or latent syphilistrue
  53. 53syphilis acquired in first trimester s/snonimmune hydrops fetalis, maculopaupular rash, anemia, low plts, hepatosplenomegaly, edematout placenta, perinatal mortality 50%
  54. 54late acq syphilis s/s appear at 2 yrs of agehutchinson teeth, mulberry molars, saddle nose, saber shins, deafness
  55. 55c section prevents spread of congenital syphilisfalse
  56. 56dx of syphilisVDRL or RPR screen and confirm with FTA-ABS or MHA-TP; screen neg in primary syphilis so bx ulcer with darkfield
  57. 57tx syphilis in mothersIM benzathine PCN x1
  58. 58how do neonates contract HBVfrom primary infection in 3rd trimester or ingest genital secretions; 80% will develop chronic hep unlike adults where only 10% contract chronic hep
  59. 59if 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
  60. 60prevent spread to neonate of hep Bnot 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)
  61. 61tx of hep in infantimmunize and HBIG; chronic treat with interferon or lamivudine
  62. 62review breakdown of HTN in pregnancypg 394 and 395
  63. 63never give ACE i of thiazides in preg to control BPtrue
  64. 64HELLP can occur...in the third trimester and pospartum as well (2days after delivery)
  65. 65risk factor of HELLP different from preeclampsiawhites, multigravids and women of older maternal age
  66. 66tx of HELLPimmediate 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.
  67. 67complications of HELLPDIC, abruption, fetal demise, ascites, hepatic rupture
  68. 68never use an ACE I or ARB during pregnancytrue
  69. 69loop diuretics, nitrates, BB may be continuedtrue
  70. 70digoxin can be used to control HF symps in pregnancy but it does not effect outcometrue
  71. 71use rate control in preg patients; do not give amiodarone or coumadintrue
  72. 72Endocarditis ppx is the same as nonpreg pts, don't need ppx for actual delivery or c sectiontrue
  73. 73regurgitant lesions are fine in preg but stenotic lesions are exacerbated and increase materal/fetal mortalitytrue
  74. 74mital stenosis in preg has increased risk pulm edema and afibtrue
  75. 75PE is leading cause of maternal death in US; 50% who get it have a hypercoagulable disease...when do we give DVT/PE ppxafib with heart disease (but not lone afib), Antiphospholipid syndrome, HF with EF<30%, Eisenmenger syndrome
  76. 76in patient with prior history or reason of anticoagulation what do we give?ppx LMWH; intrapartum unfractioned heparin, and coumadin 6wks postpartum
  77. 77hyperthyroid in preg causesFGR and still birth
  78. 78hypothyroid in preg causesintellectual def and miscarriage
  79. 79preg does not effect S/S of hyper or hypothyroidism and normal lab values of free T4/TSHtrue
  80. 80increase thyroid hormone dose in hypothyroid in preg by 25-30%true
  81. 81drug of choice for hypothyroid in pregsynthroid
  82. 82symptomatic hyperthyroid useBB not radioactive iodine
  83. 83tx grave's dz in pregPTU may cause hypothroid in fetus; congenital graves can be masked for until 7-10d after birth
  84. 84maternal TSIG can cross the placenta and causefetal tachy, FGR, goiter
  85. 85target BS in pregFBS<90 and <120 1 hr after a meal
  86. 86Diabetes mgmt in pregstart with lifestyle changes, add insulin if no control, avoid oral agents when breast feeding can cause fetal hypoglycemia
  87. 87routine monitoring in preg patientsA1c 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
  88. 88GDM post partum carecheck 2 hr 75g OGTT at 6-12wks postpartum; 35% develop over DM 5-10yrs after delivery
  89. 89rare congenital abn in over DM mothercaudal regression syndrome.
  90. 90A1C>8.5 in first trimester assoc with whatcongenital malformations (NTD); not true of GDM since hyperglycemia is not seen in the first trimester
  91. 91labor mgmt in diabetic patienttarget 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
  92. 92fetal problems with diabetic motherhypoglycemia, hypocalcemia, polycythmia, hyper bili, RDS
  93. 93european preg patient with twins, has intractable puritis worse at night on palms and soles and elevated Biliintrahepatic cholestasis in preg (tx is ursodeoxycholic acid)
  94. 94acute fatty liver in pregnancydue 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)
  95. 95tx asx bacturia in pregmacrobid or amoxicillin or cefalexin
  96. 96tx of pyelonephritis in pregIVF and IV cephalosporin or gentamicin and tocolysis
  97. 97when can D and C be done for abortionbefore 13wks gestation
  98. 98when can we use misoprostol for abortionused in the first 63 days of amenorrhea
  99. 99second trimester methods of abortionD and E and partial birth
  100. 100spontaneous birth occurs when <20wks adn <500g fetustrue
  101. 101fetal demisein utero death after 20wks, loss of fetal movements
  102. 102half of preg complicated by threatened abortion go to termtrue, you need a speculum exam and check for doppler for fetal cardiac activity
  103. 103pregnant woman with bleeding, painful cramps and dilated cervix on examinevitable abortion
  104. 104loss of early preg but no S/S, and no cardiac activity on USmissed abortion
  105. 105mgmt of incomplete abortionUS confirms debris and you need to do a D/C
  106. 106mgmt of complete abortionno debris on US check serial B HCG to be sure an ectopic was not missed
  107. 107what is a complication that needs to be ruled out with fetal demisecheck coags to r/o DIC; if it's there then the baby needs to be delivered immediately
  108. 108tx of ectopic pregif ruptured surgery if not can use MTX, give rhogam to RH neg woman, f/u BHCG to ensure complete removal of fetus
  109. 109when do you use MTX in ectopicif <3.5cm, no fetal heart sounds, bHCG<6000, no hx of folic supplementation
  110. 110what do you need to r/o before perform cerclage for cervical insuffr/o chorioaminionitis
  111. 111tx of cervical insuffelective cerclage at 13-16wks with >3 unexplained midterm preg losses; remove it at 36-37wks gestation
  112. 112short cervix on exam at 16 wks, but no symps or dilated cervix what do we do?monitor with US if short at 20wks
  113. 113define IUGREFW 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)
  114. 114review IUGR chartp. 406
  115. 115define macrosomiaEFW>90-95% of gestation age or birth wgt 4000-4500g
  116. 116Diagnose PROM or ROMsterile vaginal exam seen posterior fornix pooling, nitrazine positive, ferning positive, US oligohydraminos
  117. 117clinical dx of Chorioamnionitismaternal fever and uterine tenderness, confirmed ROM, abs of URI/UTI
  118. 118what to do with PROM<24 wks gestationmanage at home on bed rest
  119. 119PROM mgmt at 24-33weekshospitalize give IM betamethasone, cervical cx, ppx amoxicillin and erythromycin for 7 days
  120. 120PROM mgmt at 34wksinitiate delivery
  121. 121review stage of laborp. 409
  122. 122mgmt umbilical cord prolapsedon'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
  123. 123changes in FHR on monitor are related to the followinguterine hyperstim, fetal head compression, umbilical cord compression, placental insuff
  124. 124nl FHR110-160bpm
  125. 125FHR tachy/ brady due to the followingtachy (meds- beta agonist, terbutaline, ritodrine); brady (BB or local anesthetics)
  126. 126Acceleration on monitorabrupt increase in FHR<2min and unrelated to contractions (reassure)
  127. 127Early deceleration on monitorgradual dec in FHR begin and end with contraction due to fetal head compression
  128. 128variable decleration on monitorabrupt dec in FHR unrelated to cxn; due to umbilical cord compression; indicate fetal acidosis (not reassure)
  129. 129late deceleration on monitorgradual dec in FHR come delayed in relation to CXN; uteroplacental insuff, indicate fetal acidosis (bad)
  130. 130variability on monitor6-25BPM between and is reassuring
  131. 131stepwise approach to nonreassuring fetal tracecheck 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)
  132. 132optimum time for external versionfor 37wks and success is 60-70%
  133. 133breast feeding buys you 3 months off birthcontroltrue
  134. 134Diaphragm and IUD should no be placed for 6 wk after deltrue
  135. 135combined birth controlnot used for 3wks post del to prevent dvt; not used if breast feeding due to decreased lactation
  136. 136progesterone only can be used right after deltrue
  137. 137review post partum fever chartp. 414

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Step 3 cards FlashCards sobre Step 3 - Obstetrics, criado por Jaimie Shah em 31-10-2013.
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Jaimie Shah
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