11 Flashcards
Symptoms of intrahepatic cholestasis of pregnancy
Itchy without lesions
High bile acids
Leads to fetal distress, prematurity, gallstones
Treatment of intrahepatic cholestasis of pregnancy
Antihistamines, cornstarch baths
Bile salt binder, ursodeoxycholic acid, cholestyramine
Acute fatty liver of pregnancy
Microvesicular steatosis of liver
Ruq pain, renal failure, liver failure, hypoglycemic, jaundice, bilirubin
Deliver the infant!
Most common cause of maternal mortality
Thromboembolism
Neonate eye drops of erythromycin is for
Gonococcal eye infection
Neonates with chlamydia ophthalmic infections treated with
Oral erythromycin 14 days
Pregnant moms with chlamydia treated with
Erythromycin or amoxicillin 7 days
Or azithromycin 1 dose
Thyroid levels in pregnancy
Free T4 and TSH unchanged (euthyroid)
But high tbg and total t4
Estimated due date
LMP - 3 months + 7 days + 1 year
Pyelonephritis in pregnancy complications
*sepsis
Ards
Preterm
Gestational diabetes screen and guidelines
26-28 weeks then 6 weeks post partum
Fasting 95-105
1 hr 180-190
2 hr 155-165
3 hr 140-145
Vacuum aspiration/ d and c
6-16 weeks
10-15 min
Dilate and suction
Dilation and evacuation
16-21 weeks
15-30 min
Fetal death shot and dilate
Cannula removes tissue
Curettes scrapes
Final suction
Dilate and extraction
> 21 weeks
Dilate two days before
Water breaks third day
Fetus rotated and forceps pulls out parts
Skull incision to collapse
Most common location for ureteral injury
Cardinal ligament (cervix to pelvic side wall)
types of abortions
threatened: vag bleeding, no dilation (US, hcg)
inevitable: cramping, bleed, dilation, no leak (d&c, med)
Incomplete: cramp, bleed, dilate, some leak (dc, med)
complete: all tissue passed, cervix closed, cramps stopped (follow hcg)
missed: fetal demise, no symptoms (d&c, meds, wait)
types of emergency contraceptions
plan B- 2 dose or 1 dose- levongestrel (w/in 72 hrs) combo E and P (preven) 2 doses (72 hours) ulipristal 1 dose- progesterone modulator (5 days) copper iud (7 days)
management of abnl colpo for ecto and endo
ecto: LEEP, cryo
endo: cone biopsy
but if >2IIb–> chemo
Dx and Tx of ovarian cancer
Dx: 1. transvag US 2. CT 3. track CA-125
Tx: TAH BSO + paclitaxel
management of molar pregnancy
suction and curretage
OCP
follow bHCG
primary amenorrhea defintion
no secondary sex characteristics by age 13
no period by 15
secondary amenorrhea definition
3 consecutive period losses
Normal puberty ages
breasts-8
axillary-9
growth- 10
menarche-11
when do you screen for gestational diabetes?
after 20 weeks
when do you screen for maternal anemia?
28 weeks
how and when do you test for fetal anemia
after 20 wks: transcranial doppler
after 20 and before 34: Percutaneous umbilical blood sampling (PUBS) to confirm. gives access to transfuse
how long should each stage of labor should be?
stage 1: latent and active- 20 hours (nuli), 14 hours (multi)
stage 2: active to fetus delivery = 3 hours (n), 2 hours (m)
stage 3: to placenta delivery- <30 min
management of abnl latent phase
balloon
amniotomy
misopristol
oxytocin
manage abnl active phase
- oxytocin
2. c-sect
manage abnl stage 2
- oxytocin
2. if - station : c sect. if + station- forceps/vacuum
manage abnl stage 3
- uterine massage
- oxytocin
- manual extraction
non stress test measures…
fetal HR (variability, accels)
BPP measures
NST amniotic fluid index breathing movement tone
8-10: reassure
contraction stress test
decels, bradycardia- need 3 contractions/10 min
what level of titers of antibodies to have an effect?
> 1:8
