8 OB Flashcards
at what rate does the b-HCG rise during the first 4 weeks of normal pregnancy?
doubles evry 48 hrs
What do the “triple” and “quad” screens include?
When should they be performed?
- maternal serum alpha fetoprotein (MSAFP)
- beta-HCG
- estriol
quad 4. inhibin A
15-18 weeks gestation
Combines with an increased MSAFP what does this indicate?
neural tube defect
(compression of the cerebellum in posterior fossa)
What does the first screening include?
When is it performed
Combined Test:
- HCG
- PAPP-A
- nucal translucency
9-13 wks
When can the cell -free DNA testing be performed?
7 wks
What does the Quad test for a trysomy 21 look like?
MSAFP ↓
bHCG ↑
estriol ↑
inhibin A ↓
What does the Quad test for a trysomy 18 look like?
MSAFP ↓
bHCG ↓
estriol ↓
Normal Biophysical Profile (BPP)
*in 30 minutes
- NST ≥ 2 accelarations (15bmp)
- Fetal Breathing ≥ 1 lasting 30 seconds
- Fetal Movements > 3
- Fetal Muscle Tone ≥ 1 episode of flex/ext
5 Amniotic Fluid Index ≥ 2 cm max vertical pocket
birth steps
- engagement
- descent
- flexion
- internal rotation
- extension
- external rotation
- expulsion
most common implantation site for ectopic pregnancies?
ampulla
(90% in fallopian tube, 70-80% ampulla)
Qualifiers for treatment of ectopic pregnancy with metotrexate?
- sable
- available for follow up
- bHCG <5000
- no fetal heart rate
- lab tests normal
- CBC
- blood type/screen
- liver function
- kidney function
Contraindications for treatment for ectopic pregnancy with metotrexate?
- does not neet criteria
- inmunodeficiency
- concurrent viable pregnancy
- ruptured ectopic pregnancy
- breats feeding
- hypersensitivity to metrotraxate
relative:
- >3.5 mass
- fetal heart rate
When should preterm labor occur?
MATERNAL
- severe HTN
- cardiac disease
- hemorrage
PREGNANCY
- cervical dilation >4 cm
- premature membrane rupture >34 wks
- chorioamnionitis
FETAL
- death
- distress
- IUGR with reverse diasistolic flow
What should I give a patient with:
- >37 wks gestation
- unknown GBS
- PROM >18 hrs
prophylactic penicilin!
up to what weeks can I administer corticosteroids to a patient with preterm labor?
up to 34 wks
GA: 24-36.6
weight 600-<2500
up to what weeks can I administer corticosteroids to a patient with PPROM?
32 wks
what is the first thing I should think about when I have a patient with third semester bleeding?
placenta previa
what exam is contraindicated in a patient with suspected placenta previa?
digital exam!!!
do not introduce anything in the vagina -> no transvaginal US
what are some of the risk factors of placental abruption?
HTN
cocaine use
smoking
trauma
previous abruption
what is the treatment for uterine rupture?
immediate laparotomy with delivery of the fetus
In what scenarios is the RhoGAM given (to unsensitized patients)?
- abortion
- delivery
- vaginal bleeding
- placental abruption
- amniocentesis
what is the antidote of magnesium sulfate?
calcium gluconate
symmetric IUGR
brain in proportion to body
before 20 wks
intrinsic factor
asymmetric IUGR
brain weight is NOT decreased
abdomen smaller than the head
after 20 wks
extrinsic factors
empiric treatment for asymptomatic bacteriuria
- nitrofurantoin
- amoxicillin
- cephalexin
when should women be tested for asymptomatic bacteriuria?
12-16 wks
what is the treatment sequence for hyperemesis gravidarum
- dietary modification + avoidance of triggers + non-pharmachological (acupuncture, giner, vitamin B6)
- diphenydramine
- metoclopramide
- ondansetron
antibiotics that should be avoided during pregnancy
- TMP-SMX (1st trim)
- aminoglucosydes
- tetracyclines
- fluoroquinolones
drugs that can be used to treat hypertension (chronic and gestational) during pregnancy?
metildopa
labetalol
nifedipine
what is the only definitive treatment of preeclampsia?
delivery!
thyroid disease in pregnancy:
what crosses the placenta?
TRH
inmunoglobulins against TSH receptor
thyroid disease in pregnancy:
what does not cross the palcenta?
TSH
T4
type of deceleration?
what does it indicate?
early decelerations
head compression
type of deceleration?
what does it indicate?
variable decelerations
umbilical cord compression
type of deceleration?
what does it indicate?
late decelerations
fetal hypoxia
DELIVER!
Duration of the stages of labor:
Stage 1
primigravid: 6-18
multipara: 2-10
Duration of the stages of labor:
latent phase / active phase
latent phase:
- primigravid: 6-7
- multipara: 4-5
active phase:
- primigravid: >1.2 cm/hr
- mulitpara: >1.5 cm/hr
what is the treatment for septic abortion
D&C + IV ATB
Clindamycin + gentamycin
Cefoxitin + doxicycline
