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1Current > 1MTB step 3 OB > Flashcards

1MTB step 3 OB Flashcards

1
Q

Transvaginal and Abdominal ultrasound bHCG and wks

A

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

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2
Q

fetal heart motion time

A

5-6 weeks

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3
Q

fetal heart sounds time

A

8-10 weeks

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4
Q

When can fetal motion be felt by doctor

A

20 weeks

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5
Q

first trimester tests

A

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

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6
Q

low hemoglobin

A

MCC is fe def anemia worry if < 10

check MCV : low = fe high =folate

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7
Q

Who gets Rhogam

A

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.

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8
Q

UTI

A

asymptomatic bacturia must treat nitrofurantoin <30 weeks cephalosporins amoxicillin

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9
Q

Infection: Chlamydia/ Gonorrhea

  1. Tests
  2. Dx significance
  3. Next step in Mgmt
A
  1. Test: Cervical Culture
  2. Dx Significance:
    a. Gram stain
    b. Chlamydia and gonorrhea culture
    c. Also treat Trichomonas vaginalis (can cause premature labor).
  3. 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
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10
Q

Bacterial vaginosis

A

metronidazole

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11
Q

trichomonas vag

A

metronidazole

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12
Q

+ ppd ? check CXR and tx

A

+ ppd - cxr : INH + B6 x 9 months + ppd + cxr + sputum: triple therapy no streptomycin

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13
Q

trisomy 21 screen in first trimestery

A

who: > 35 y/o, history of prior trisomy 21 chorionic vili sampling

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14
Q

2nd trimester screen

A
  1. Triple/Quad screen:Screen
    15-20 weeks:

MS-AFP, B-hCG, Estriol, Inhibin A

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15
Q

inc AFP causes

A

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

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16
Q

down syndromme triple screen

A

dec AFP dec estriol inc HCG

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17
Q

Trisomy 18 triple screen

A

dec AFP dec estriol dec HCG

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18
Q

inc AFP what to do next?

A

amniocentesis for AFP + acetylcholineresterase activity (NTD)

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19
Q

dec AFP

A

amniocentesis for karyotyping

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20
Q

third trimester screen (>24 weeks)

A

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

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21
Q

DM screen:

A
  1. 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
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22
Q

NAME?

A

penicillin G intrapartum clinda or erythro if pen allergic

23
Q

N/V during preg

A

1) zofran 2) reglan 3) B6 4) doxyalamine 5) promethazine

24
Q
A
25
Q

steps third trimester bleeding

A

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

26
Q

placental abruptio

A

painful bleeding RF: cocaine, trauma, HTN, complication : DIC TX: <34 weeks and stable –> monitor > 34 weeks –>> deliver unstable –>> deliver

27
Q

placental previa

A

painless bleeding RF: trauma, previous previa, fibroids, age Complication: placental accreta TX: <34 weeks and stable –> monitor > 36 weeks –>> vaginal deliver unstable –>> deliver

28
Q

vasa previa

A

painless bleeding + fetal bradycardia + rupture of membranes NO speculum exams complications: fetal exsanguination Tx: c section

29
Q

uterine rupture

A

abd pain + vaginal bleeding + stop of contractions + fetus rescends + loss of fetal HR tx: immediate delivery

30
Q

tx for GBS

A

intrapartum: IV amp pen allergic: cefazolin, clinda, erythro

31
Q

indication tx GBS

A

previous preg neonatal GBS sepsis + anytime during preg preterm, rupture >18 hrs, maternal fever,

32
Q

no tx GBS

A

planned C-section with no ROM culture + prev preg

33
Q

toxo congenital

A

1) hydrocephalus 2) intracranial calcifications 3) chorioretinitis

34
Q

mom with toxo treatment

A

sulfadiazine + pyramethamine

35
Q

varicella when most infectious tx:

A

rash 2 days before to 5 days afterwards baby: IVIG + IV acyclovir mom: acyclovir + IVIG

36
Q

varicella congenital

A

1) rash 2) chorioretinitis 3) cataracts 4) microcephaly

37
Q

congenital rubella

A

1) blueberry muffin rash 2) cataracts 3) HSM 4) heart: PDA 5) congenital deafness + cataracts

38
Q

why does gestational DM develop

A

human placental lactogen inc insulin resistance induces lipolysis

39
Q

how to measure gestational age in 1sst trimester

A

transvaginal u/s for crown rump length

40
Q

HSV 1. when to suspect in mom

A
  1. malaise, genital lesions, fever
41
Q

HSV congenital

A

1) meningoencephalitis 2) PNA 3) hepatosplenomegaly 4) petechial rash 5) jaundice

42
Q

HSV diagnosis

A

HSV PCR or culture

43
Q

HSV treatment

A

if genital lesions are suspected schedule C section treat mom with IV acyclovir

44
Q

HIV treatment

A

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

45
Q

HIV tx newborn

A

zidovudine for 6 wks

46
Q

early congenital syphilis

A

1) hydrops fetalis 2) maculopapular rash on palms and soles 3) anemia, thrombocytopenia 4) large placenta

47
Q

late congenital syphilis

A

1) hutchinsons teeth 2) mulberry molars 3) saber shins 4) saddle nose 5) deafness

48
Q

syphilis tx

A

benzathine pen x 1

49
Q

HBV infectivity

A

check hbe Ag

50
Q

treatment ofr HB s Ag + mom

A

IVIG + Hep vaccine to mom and baby

51
Q

Chronic HTN

A

hx of elevated BP > 140/90 before preg or before 20 weeks gestation

52
Q

gestational HTN

A

after 20 weeks and returns to normal 6 weeks after BP > 140/90

53
Q

Cause of Anemia in pregnancy

A

Anemia in pregnancy is caused by increased levels of hepcidin, which inhibits iron transport. Pregnancy increases iron demand, but hepcidin prevents absorption.

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