A Exam Review 2012 Flashcards
Treatable causes of non-immune hydrops
MOST COMMON:
- fetal tachyarrythmias
OTHER:
1. IU transfusion for anema: fetal hemolysis (G6PD), fetal parvo, MFH
2. Centesis or shunt placement: Chylothorax, CCAM
3. Medical Tx: fetal tachyarrythmia or AV block (antiSS-A/B)
4. Fetal procedures: CCAM, sequestration, Sacrococcygeal teratoma, TTTS, fetal tumors
5. Anythyroid meds for fetal thyrotoxicosis
Causes of non immune hydrops in order of prevalence
- cardiac (22%)
- structural
- cardiomyopathies
- arrythmia - idiopathic (18%)
- chromosomal (13%)
- hematologic (10%)
- infectious (7%)
Indications for uterina artery Dopplers
Previous History:
(1) early onset GHTN
(2) Abruption
(3) IUGR
(4) IUFD
Current Pregnancy
(5) Pre-existing HTN, renal disease
(6) T1DM with complications (nephropathy, retinopathy, vascular)
(7) Abnormal serum markers (high AFP, low PAPP A)
Causes of fetal tachycardia
Maternal:
- fever, infection
- Dehydration
- Hyperthyroidism
- endogenous
- adrenaline/anxiety
- anemia
- Medication related
Fetal:
- infection
- active fetus
- chronic hypoxemia
- Anemia
- Cardiac anomalies
- Congenital anomalies
Risk factors for cervical Incompetence and what 2 are the most common
Most Common - Recurrent MidT loss - Prior PTB Other - PPROM < 32 wks - Prior preg with Cx length < 25mm at < 27 wks - maternal DES exposure in utero - Congenital uterine anomaly - Mat connective tissue d/o - Hx Cx Trauma: repeat TAs, repeat Cx dilatation, cone biopsy, Cx tears/lacerations, trachelectomy
Treatment for PID
Inpt:
- Cefotetan or Cefoxitin 2g IV q12h and Doxycycline 100mg PO/IV q12h
Outpt:
Ceftriaxone 250mg IM x 1 and Doxy 100 BID x 14 days +/- flagyl 500 BID x 14 days (as per CDC as limited coverage)
Diagnosis and Tx of BV
Dx (Amsel’s Criteria)
- Vag Discharge
- pH > 4.5
- KOH whiff test
- clue cells
Tx:
- Flagyl 500mg PO BID x 7 days
- Flagyl 0.75% I applicator PV qHS x 5 days
Features of molar pregnancy (complete and partial)
Complete:
- 46XX (90%) or XY
- no fetal tissue
- diffuse villous edema
- diffuse trophoblastic proliferation
- p57 neg
- 15% progression risk
Partial:
- 69XXY or XXY
- fetal tissue
- focal villous edema
- min/focal trophoblastic proliferation
- p57 pos
- 4-6% risk malignant sequelae
Mg Sulf:
- How does it reduce Ca
- symptoms of hypocalcemia
- antidote
- What mag level correlates with:
- loss of deep tendon reflexes
- respiratory paralysis
- cardiac conduction abn
- arrest - When do you draw a mag level
- transient reduction in Ca by 1. suppression of parathyroid hormone
- myoclonus, delirium
- Ca Gluc 15-30ml of 10% solution (1500 - 3000mg) IV over 3-5 mins
- 7-10
- 10-13 meq/ml
- > 15
- > 25
- Seizure on mg sulf, symptoms mag toxicity, renal insufficiency
Molar preg:
- FU post op
- Reasons to refer
- (a) follow betas weekly until 3 neg then monthly until 3-6 months neg
(b) ocp (not IUD as inc risk perforation) - choriocarcinoma or placental site tumor
- BHCG: > 20 000 post evac, < 10% drop in beta/plateau of beta x 3 values, pos beta after 6 months
- mets on CXR
Indications for surgery endo polyp
(1) AUB, PMB
(2) Infertility
(3) Multiple polyps
(4) > 1.5 cm
(5) Prolapsed through cervix
Clinical diagnostic Criteria for APLAS
1 or more of:
- Vascular Thrombosis (Superficial venous thrombosis does NOT qualify)
- Pregnancy Morbidity:
- 1+ death or morph nml fetus > 10 weeks or
- 1+ PTB morph nml fetus < 34 weeks s/t eclampsia, preeclampsia, placental insufficiency or
- 3+ consecutive SA < 10 wks unexplained by other causes
Lab Criteria for diagnosis APLAS
1+ of the following on 2+ occasions at least 12 weeks apart
- elevated anticardiolipin antibodies
- elevated anti-beta2-glycoprotein
- Positive Lupus anticoagulant
Quintero Staging for TTTS
- Poly/Oli
- bladder donor absent
- abn Dopplers
- Hydrops
- Death
As per ALARM, What is the risk of placenta accretta in a patient with placenta previa and — number of previous CS:
0,1,2,3,4+
0 – 3% 1 – 11% 2 – 40% 3 - 61% 4+ - 67%
