1MTB step 3 OB Flashcards
Transvaginal and Abdominal ultrasound bHCG and wks
Vaginal sonogram at 5 weeks gestation when serum ß-hCG >
1,500 mIU
Abdominal sonogram at 6 weeks gestation when ß-hCG >
6,500 mIU
fetal heart motion time
5-6 weeks
fetal heart sounds time
8-10 weeks
When can fetal motion be felt by doctor
20 weeks
first trimester tests
A.Routine tests
1) Anemia/ blood disorders: CBC
2) Blood type, Rh, and antibody: Type and screen, Direct & indirect Coombs
3) GU Screening: Cervical PAP smear, UA, UCx
4) Immunization: Rubella Ab, Hep B surface antigen
5) Infections:
-Chlamydia/Gonorrhea: Cervical Cx, Gram stain
-HIV: ELISA
-Syphilis: Screen: VDRL or RPR
Confirmatory tests: FTA or MHA-TP
B. Optional Tests
1) TB: PPD
2) Trisomy 21: B-hCG, PAPPA-A, fetal nuchal translucency
low hemoglobin
MCC is fe def anemia worry if < 10
check MCV : low = fe high =folate
Who gets Rhogam
1) At 28 weeks.
2) Within 72 hours of delivery.
3) After miscarriage or abortion.
4) During amniocentesis or CVS.
5) With heavy vaginal bleeding.
UTI
asymptomatic bacturia must treat nitrofurantoin <30 weeks cephalosporins amoxicillin
Infection: Chlamydia/ Gonorrhea
- Tests
- Dx significance
- Next step in Mgmt
- Test: Cervical Culture
- Dx Significance:
a. Gram stain
b. Chlamydia and gonorrhea culture
c. Also treat Trichomonas vaginalis (can cause premature labor). - Next Step in Mx:
a. (+) Chlamydia/gonorrhea
- PO azithromycin + IM ceftriaxone (TOC)
- Alternative: PO amoxicillin
b. (+) Bacterial vaginitis
- PO metronidazole or clindamycin
c. (+) Trichomonas vaginalis
- PO metronidazole
Bacterial vaginosis
metronidazole
trichomonas vag
metronidazole
+ ppd ? check CXR and tx
+ ppd - cxr : INH + B6 x 9 months + ppd + cxr + sputum: triple therapy no streptomycin
trisomy 21 screen in first trimestery
who: > 35 y/o, history of prior trisomy 21 chorionic vili sampling
2nd trimester screen
- Triple/Quad screen:Screen
15-20 weeks:
MS-AFP, B-hCG, Estriol, Inhibin A
inc AFP causes
check US for more accurate gestational age 1. wrong age 2. multiparity 3. NTD or abd wall defect 4. placental bleeding 5. renal disease 6. sacrococcygeal teratoma
down syndromme triple screen
dec AFP dec estriol inc HCG
Trisomy 18 triple screen
dec AFP dec estriol dec HCG
inc AFP what to do next?
amniocentesis for AFP + acetylcholineresterase activity (NTD)
dec AFP
amniocentesis for karyotyping
third trimester screen (>24 weeks)
24-28 wks:
- Anemia: CBC
- Diabetes: 1hr 50 g OGTT –> 3 hr 100g OGTT
28 wks:
-Atypical Ab (Rh): Indirect Coombs
35-37 wks:
-GBS screening: Vaginal & Rectal Cx for GBS
DM screen:
- 1 hour 50 g test + > 140 2. 3 hour gluc tolerance test fbs >125 1 hr >180 2 hr >155 3 hr >140 if 1+ then gluc intolerance if 2+ then DM
NAME?
penicillin G intrapartum clinda or erythro if pen allergic
N/V during preg
1) zofran 2) reglan 3) B6 4) doxyalamine 5) promethazine
steps third trimester bleeding
1) vitals, external fetal monitor, start IVF, 2) CBC, DIC, type and cross, OB US to r/o previa 3) give blood, foley, vaginal exam, delivery if >36 wks and in jeopardy 4) NO digital or speculum until r/o previa
placental abruptio
painful bleeding RF: cocaine, trauma, HTN, complication : DIC TX: <34 weeks and stable –> monitor > 34 weeks –>> deliver unstable –>> deliver
placental previa
painless bleeding RF: trauma, previous previa, fibroids, age Complication: placental accreta TX: <34 weeks and stable –> monitor > 36 weeks –>> vaginal deliver unstable –>> deliver
vasa previa
painless bleeding + fetal bradycardia + rupture of membranes NO speculum exams complications: fetal exsanguination Tx: c section
uterine rupture
abd pain + vaginal bleeding + stop of contractions + fetus rescends + loss of fetal HR tx: immediate delivery
tx for GBS
intrapartum: IV amp pen allergic: cefazolin, clinda, erythro
indication tx GBS
previous preg neonatal GBS sepsis + anytime during preg preterm, rupture >18 hrs, maternal fever,
no tx GBS
planned C-section with no ROM culture + prev preg
toxo congenital
1) hydrocephalus 2) intracranial calcifications 3) chorioretinitis
mom with toxo treatment
sulfadiazine + pyramethamine
varicella when most infectious tx:
rash 2 days before to 5 days afterwards baby: IVIG + IV acyclovir mom: acyclovir + IVIG
varicella congenital
1) rash 2) chorioretinitis 3) cataracts 4) microcephaly
congenital rubella
1) blueberry muffin rash 2) cataracts 3) HSM 4) heart: PDA 5) congenital deafness + cataracts
why does gestational DM develop
human placental lactogen inc insulin resistance induces lipolysis
how to measure gestational age in 1sst trimester
transvaginal u/s for crown rump length
HSV 1. when to suspect in mom
- malaise, genital lesions, fever
HSV congenital
1) meningoencephalitis 2) PNA 3) hepatosplenomegaly 4) petechial rash 5) jaundice
HSV diagnosis
HSV PCR or culture
HSV treatment
if genital lesions are suspected schedule C section treat mom with IV acyclovir
HIV treatment
continue ARTs during preg regardless of viral load till 6 weeks after Zidovudine in one of hte meds do triple therapy Elective C section of viral load > 1000 DO NOT breastfeed
HIV tx newborn
zidovudine for 6 wks
early congenital syphilis
1) hydrops fetalis 2) maculopapular rash on palms and soles 3) anemia, thrombocytopenia 4) large placenta
late congenital syphilis
1) hutchinsons teeth 2) mulberry molars 3) saber shins 4) saddle nose 5) deafness
syphilis tx
benzathine pen x 1
HBV infectivity
check hbe Ag
treatment ofr HB s Ag + mom
IVIG + Hep vaccine to mom and baby
Chronic HTN
hx of elevated BP > 140/90 before preg or before 20 weeks gestation
gestational HTN
after 20 weeks and returns to normal 6 weeks after BP > 140/90
Cause of Anemia in pregnancy
Anemia in pregnancy is caused by increased levels of hepcidin, which inhibits iron transport. Pregnancy increases iron demand, but hepcidin prevents absorption.
