amboss pregnancy Flashcards
what is the best strategy for avoiding SIDS
having the baby sleep in supine position, without blankets or pillows, avoiding secondhand smoke. do not ever sleep with the baby
is a fetus at risk for rubella
yes, but only if infected after 20 weeks gestations
what is the presentation of rubella
post auricular lymphadenopathy, rash that spreads from the face to the periphery.
what is the treatment for rubella
there is no specific treatment
what is the presentation of congenital rubella infection
Cataracts: Other eye manifestations may also occur later in life (e.g., salt and pepper retinopathy, glaucoma).
Cochlear defect: bilateral sensorineural hearing loss
Cardiac defect: most common defect (e.g., patent ductus arteriosus, pulmonary artery stenosis)
TRIPLE C Cardiac anomaly, Cataracts, cochlear defects
what is the presentation of congenital CMV infection
Increased risk of fetal demise
Intrauterine growth restriction
Oligohydramnios or polyhydramnios, placental abnormalities
periventricular calcifications, hyperechogenic foci (bowel and liver, ascites), and hydrops fetalis intraventricular hemorrhage
Microcephaly .
Sensorineural hearing loss (∼ 30%)
Chorioretinitis (∼ 10%)
what is the treatment for congenital CMV
Severe anemia: intrauterine blood transfusions
Thrombocytopenia: platelet transfusions
Newborn
Supportive therapy of symptoms (e.g., fluid/electrolyte imbalances, anemia, thrombocytopenia, seizures, secondary infections)
Ganciclovir, valganciclovir, or foscarnet
Mother: valacyclovir is the only therapy approved during pregnancy; trials with CMV specific hyperimmune globulin ongoing
which herpes is responsible for congenital herpes
HSV-2; rarely 1
congenital herpes infection
Intrauterine HSV infection (congenital herpes simplex virus infection) (∼ 5% of cases)
Fetal demise, preterm birth, very low birth weight
Microcephaly, hydrocephalus, and other CNS defects
Microphthalmia → chorioretinitis
Vesicular skin lesions
Perinatal and postnatal transmission
Skin, eye, and mouth disease
Vesicular skin lesions
Keratoconjunctivitis → cataracts, chorioretinitis
Vesicular lesions of oropharynx
CNS disease
Meningoencephalitis (manifesting with fever, lethargy, irritability, poor feeding, seizures, bulging fontanelle)
Possibly vesicular skin lesions
what is the treatment for postpartum endometritis
IV clindamycin and gentimicin
alternatively amipicillin-sulbactam for clindamycin
what causes pulmonary and hepatic granuloma of the newborn
this is granuloma infantiseptica which is caused by listeriosis
if a Rh(-) mother gave birth to a Rh(+) baby what is the next child at risk of
hemolytic disease of the newborn.
what is the prevention for hemolytic disease
Rhogan anti-D immunoglobulin
what are the screening parameters for Rh-D
If the first anti-D screen shows that the mother is unsensitized, guidelines recommend that she should undergo repeat screening between 24 and 28 weeks’ gestation, If the anti-D screen remains negative, anti-D immunoglobulin should be administered in the 28 week’ gestation and within 72 hours following delivery of a Rh(D) positive child.
when do RhD(-) mothers not need anti-D immunoglobulin
If the father of the baby is Rh(D) negative.
what is the presentation of varicella in the newborn
vesicular like rash, pneumonia and encephalitis
what is the management for a birthing mother with active herpes infection
oral acyclovir and C-section
what is the risk for vertical transmission of HSV if the birthing mother has an active infection
The risk for vertical transmission to the neonate from an infected mother is high (up to 50%) among women who exhibit active genital herpes near the time of delivery.
what is the treatment for congenital chlamydial eye infection
oral erythromycin.
topical is preventative
what is the risk of oral erythromycin
hypertrophic pyloric stenosis
what is the risk of not treating chlamydial eye infection in the new born
chlamydial pneumonia
when is intubation recommended for neonate
if there is cyanosis, poor respiratory effort or wheezing
what is the treatment for neonatal pneumonia
ampicillin and gentamicin
what are the most likely pathogens for neonatal pneumonia
group B Streptococcus, E. coli, coagulase-negative Staphylococcus, S. aureus, Klebsiella)
what is the treatment Following confirmation of gonococcal neonatal conjunctivitis (using culture and Gram stain or PCR),
systemic treatment with either an IV or an IM 3rd-generation cephalosporin (e.g., ceftriaxone) is indicated. In addition, the eyes should be flushed with saline until the discharge clears.
Does topical antibiotic treatment cover chlamydial eye infections
NO. gonococcal only
what is the treatment for chorioamionitis
Treatment depends on whether the birth is vaginal (requiring IV ampicillin plus gentamicin) or cesarean (requiring IV ampicillin and gentamicin, plus clindamycin).
simply put, ampicillin and gentimicin. if C-section, add clindamycin
what is the most common ABO incompatibility
usually limited to mothers with O group. and this course is mild
do you give MMR to pregnant women
no. it is a live vaccine
what vaccines duo you give to unvaccinated pregnant women
Tdap and influenza
do you give varicella vaccine to pregnant women
no. live vaccine
why give Tdap top pregnant women
because of the risk of tetanus in delivery
if a pregnant woman is not vaccinated against Hep b and has never had an infection, do you vaccinate
no. low risk
what is the most likely cause of neonatal sepsis <72 hrs post birth
Strep agalacteia
what is the management of someone with chorioamionitis that is term
antibiotics and induce labor
what do you treat UTI in pregnancy
amoxicillin clav
Can you use fluoroquinolones in pregnnacy
no
Can you use Bactrim in pregnancy
yes as an alternative in the 2 and 3 trimesters. in general stay away from it
Indications for GBS prophylaxis include
maternal GBS colonization, GBS bacteriuria occurring during pregnancy, or history of a previous newborn with GBS infection (as in this patient).
what is the preferred treatment for GBS
intravenous penicillin G
if someone does not get screened for GBS and is in labor what is the management
do not screen, just treat
what is the presentation of congenital toxoplasmosis
calcifications throughout the brain, not just periventricular. hydrocephalus, ventriculomegaly, hearing loss.
what is the most immediate medical treatment for transposition of the great vessels
prostaglandin administration
baby that sweats and is uncomfortable during feedings
PDA
what is the treatment for PDA
percutaneous intervention if the child is >5kg and is full term;
indomethacin if premature or less than 5 KG
what is the presentation of meconium illues and what is the treatment for it
dilated loops of small bowel, meconium present, mircocolon.
gastrogaffin enema is both diagnostic and therapeutic. this assesses for obstruction
what cardiac condition is present in a high percentage of patients with fragile X
mitral valve prolapse/regurgitation
the prolapse leads to the regurg over time
where is cephalohematoma
under the periosteum but above the bone
subgaleeal hematoma is where
above the periosteum and under the epicranial aponeuroses
what is the presentation of subgaleal hematoma
hypotension, blood loss, pulsatile mass under the skin, tachycardia and pallor
what cardiac anomaly is present in Edwards syndroem
VSD
prognosis for edwards
The prognosis for patients with Edwards syndrome is poor, with the majority dying in utero and 5–10% surviving past 12 months of age
what cardiac malformations are present for downs and patau
VSD –same as edwards
Serum bilirubin levels > what level are suggestive of pathological jaundice
15 mg/dL
what serum bilirubin prompt phototherapy
Varies depending on age of infant.
>20 in a 4 day old infant
what is the quad test
beta hCG, inhibin A, estriol, AFP
what is the quad test for downs
decreased AFP and estriol, increased HCG and inhibin A
what is isolated elevation in AFP mean
fetal neural tube defect or open abdominal wall such as gastroparesis
what is the quad test for edwards
A decrease in AFP, free estriol, and β-HCG with normal or decreased inhibin A
what is the safest, fastest screening for downs
cell-free DNA sampling
decreased PAPPA and HCG increased suggests what
downs
what is the next step if decreased PAPPA and HCG increased
chorionic villus sampling to confirm downs
Positive pressure ventilation (PPV) via bag-and-mask is indicated immediately after birth for neonates with
a heart rate < 100 bpm, gasping respiratory effort, or apnea. Ventilation is initiated with 21% O2 at a rate of 40–60 breaths/minute.
At birth, an infant with intrauterine hypoxia may have
an elevated venous hematocrit (> 65%), respiratory distress, cyanosis, apnea, poor feeding, hypoglycemia, and plethora (ruddy complexion). Patients may also demonstrate lethargy, irritability, or seizures.
what GI abnormality is found in beck with weidenman
omphalacle
difference between gastroparesis and omphalacele
This fetus has gastroschisis, a condition in which the intestines herniate freely through an abdominal defect in the paraumbilical area; unlike omphalocele, in which the intestines protrude in the midline through the navel but are contained in a hernia sac.
what endocrinological/metabolic emergency occurs in infants with beckwith weideman
hypoglycemia
what is the presentation of transient tachypnea of the newborn
RDS in newborn Diffuse crackles on auscultation and an x-ray showing fluid within the fissures and increased lung volume support this diagnosis.
what is the difference between RDS and bronchopulmonary dysplasia
BPD is a chronic lung disease that occurs after treatment with high flow O2
gestrational diabetes puts the baby at risk for what
hypocalcemia
what is the treatment of choice for HIV pregnant women
cART throughout pregnancy and C-section at 38 weeks
neonates to HIV mothers should be treated with what
zidovudine
what is PEP for infant to HIV-mother
hint, different for viral load
For HIV-positive mothers with a viral load of ≤ 1,000 copies/mL, infant HIV PEP with zidovudine for 6 weeks is effective in preventing neonatal transmission of HIV. If the viral load is > 1,000 copies/mL (or if the mother is not on antiretroviral therapy during pregnancy), a three-drug regimen (such as zidovudine, lamivudine, and nevirapine) is recommended for PEP
what are preterm infants at risk for
iron deficiency anemia
what term infants at risk for
hemorrhage due to low vit K, and iron deficiency past four months
what drug is contraindicated in breast feeding
cocaine use
what is the presentation of poor feeding in the newborn
Neonatal unconjugated hyperbilirubinemia in the first week of life, weight loss > 10% of birth weight, and signs of dehydration (sunken anterior fontanelle, only 3 wet diapers, elevated hematocrit, and tachycardia) are suggestive of poor feeding.
Breast milk jaundice is
common in exclusively breastfed neonates and classically presents as indirect hyperbilirubinemia and moderate jaundice in an otherwise healthy infant about 2 weeks after birth.
In neonates, a normal liver can be palpated up to
3 cm baelow the costal margin. Livers larger than this may be considered enlarged and warrant further attention.
what is the treatment for missed abortion
misoprostal every 4 hours to dilate the cervix and expel the loss
what is the most accurate predictor of pregnancy age
crown rump length
what is the best contraceptive
IUD
what is a contraindication to IUD
endometritis
what is the presentation of uterine atony
enlarged, soft non-contracted uterus A congenital condition which causes abnormal development of the caudal half of the body. The most classic sign is sacral deformation, but patients generally have highly variable presentations with abnormalities in the musculoskeletal, gastrointestinal, nervous, and genitourinary systems.
what is caudal regression syndrome
A congenital condition which causes abnormal development of the caudal half of the body. The most classic sign is sacral deformation, but patients generally have highly variable presentations with abnormalities in the musculoskeletal, gastrointestinal, nervous, and genitourinary systems.
what does postterm pregnancy put the baby at risk of
meconium aspiration. really it increases the risk of meconium stained fluid, possibly due to fetal GI tract maturation, decreased clearance from the aging placenta
do you provide santiD immunoglobulin for methotrexate induced abortion
you actually give antiD immunoglobulin for extrauterine pregnancy abortion
what does chronic hypertension do to fetus
small for gestational age
what is the management of placenta previa
observation and scheduled C-section at 36-37 weeks
immediate delivery is not necessary since labor has not started
when there is placenta previa suspected do you perform a pelvic xam
no. transvaginal ultrasound
pelvic could cause hemorrhage
what is the most specific feature of uterine rupture
loss of fetal station
what do variable decelerations imply
cord compression
what is the management of cord compression
repositioning and O2 f
early decelerations are indicative of what
uterine compression of the head
what do late decelerations imply
placental insufficiency
what do accelerations imply
okay
what to do cord compression persists after repositioning and O2
amnio infusion
what ovarian complication is common with incomplete moles
theca lutein cysts due to the high B-hCG
Braxton hicks contractions are and present how
practice contractions. 20-30 min apart and last usually for less than a min. person should be discharged and told to walk if they are uncomfortable
what is the most cause of premature ROM
ascending infection
what is arrested active phase
which is defined as ≥ 6 cm cervical dilation with membrane rupture and no progress in cervical dilation after 4 hours of adequate contractions.
when is D and C appropriate to use
during the firs trimester
Retention of a dead fetus for > 2 weeks increases the risk of
systemic absorption of thromboplastin produced by the placenta and dead fetus. Thromboplastin activates the coagulation cascade and causes disseminated intravascular coagulation (DIC).
biophysical profile
It consists of four ultrasonographically measured parameters (fetal breathing, movement, tone, and amniotic fluid volume) and an optional nonstress test (modified biophysical profile). Each of the four parameters receives a score of either 0 (abnormal) or 2 (normal) points. The maximum score is 10. A score ≤ 4 indicates potential fetal compromise and delivery should be initiated.
what tests are performed at 8 weeks
hep B, HIV ELISA. rapid plasmin reagin
what tests are performed at the first prenatal visit
The CDC and ACOG recommend testing all pregnant women for HIV (using 3rd or 4th generation ELISA), syphilis (using nontreponemal tests such as VDRL or RPR), and hepatitis B infection (using HBsAg). All women that are < 25 years, have risk factors, or live in an area where prevalence is high should also be screened at the first prenatal visit for Chlamydia and N. gonorrhea infection by PCR of vaginal swabs. All of the tests should be performed at the first prenatal visit, even if previous testing for one or more of the aforementioned infections was negative.
what is PPROM and what is it associated with
A rupture of membranes before the onset of uterine contractions AND before 37 weeks’ gestation. Associated with a variety of complications, such as preterm delivery, pulmonary hypoplasia, chorioamnionitis, umbilical cord prolapse, and placental abruption.
what should be done for PPROM (say 32 weeks)
administer ampicillin and betamethasone
pregnancy can be delayed for up to 48 hours with tocolytics to allow for fetal lung maturity
when are fetal lungs mature
around 34 weeks
what does fetal hydantoin syndrome put the fetus at risk for
what agents cause it
A collection of congenital defects including intrauterine growth restriction, microcephaly, craniofacial deformities, nail hypoplasia, and mental retardation. Usually caused by maternal use of phenytoin or, less commonly, carbamazepine.
what does valproic acid put the child at risk for
inhibits folate absorption and can cause neural tube defects
what should be done if fetal position cannot be assessed by pelvic and the woman is in active labor
ultrasound
what type of breech presentation can be manipulated with external cephalic version
External cephalic version is a valid management option in pregnancies with a breech presentation or oblique/transverse lie near or at term.
when is external cephalic performed?
However, ECV must be performed before the onset of labor (usually at 37 weeks’ gestation, at maximum levels of amniotic fluid volume and optimal uterine tone and fetal weight).
what are the risks of external cephalic version
Since this woman is in active labor and is at 40 weeks’ gestation, any attempts at external version would highly risk stalling the progress of labor and fetal injury/hypoxemia.
what is the management of a traverse lie breech in active labor
C section
what is a normal AFI
An AFI between 8-18 is considered normal. Median AFI level is approximately 14 from week 20 to week 35, when the amniotic fluid begins to reduce in preparation for birth.
AFI def of oligohydraminios
An AFI < 5-6 is considered as oligohydramnios. The exact number can vary by gestational age.
what does oligohydramnios put the baby risk for
an lead to fetal compression that ultimately causes intrauterine fetal growth restriction and possibly a set of complications known as the Potter sequence. Pulmonary hypoplasia is one of the three classical features of this sequence, along with craniofacial abnormalities and limb anomalies.
what does polyhydromnios put the baby at risk for
fetal malposition as there is more fluid for the baby to move in
are some potential causes of polyhydramnios
renal dysplasia
esophageal atresia
anencephaly
what is preterm birth
any birth under 39
what is cervical insufficiency
cervical length <25 mm
what is the presentation of fetal hydrops
fluid collection in the fetal scalp, pleural effusions, anemia
what is the presnetation of atelectasis
acute onset collapse of alveoli. dyspnea, chest pain, cyanosis, opacification on CXR
risk factors for atelectasis
Cesarean section and general anesthesia are associated with reduced lung compliance, diminished ventilation, retained airway secretions, and postoperative pain resulting in poor cough and shallow breathing, which then increases the risk of atelectasis. The onset of this patient’s symptoms within 72 hours of surgery is highly suggestive of postoperative atelectasis.
what is the initial test for Rh-positivity
the rosette test
what are the follow up tests for rosette
A positive test is followed by the Kleihauer-Betke test or, in some cases, flow cytometry (if feasible) to determine the percentage of fetal RBCs in maternal circulation and the amount of anti-D immunoglobulin needed to decrease the risk of Rh sensitization.
what does a negative rosette test indicate
that a single dose of Rh-D immunoglobulin was sufficient
what is a rare pulmonary complication for preeclampsia
Pulmonary edema is a rare complication of preeclampsia and should be suspected in patients with acute onset of dyspnea and bilateral basilar crackles in the setting of gestational hypertension.
what is the cure for preeclampsia
delivery
what is Epstein anomaly and what is it associated with
an atrialized right ventricle, tricuspid regurgitation, and right atrial enlargement. Lithium i
what is the treatment for antiphospholipid sydnrome
aspirin and enoxeparin
what does b-hCG do
maintains the corpus luteum
what is twin-twin transfusion syndrome
A condition that occurs in monozygotic monochorionic twins when one twin (donor) continuously transfers blood to the other (recipient). Leads to dehydration, anemia, growth restriction, and oligohydramnios in the donor and polycythemia and polyhydramnios in the recipient. Mortality is significantly increased for both twins.
Beta-2 receptor agonists, such as terbutaline, can cause
hypokalemia by stimulating the Na+/K+-ATPase, which leads to an intracellular K+ shift. Symptoms of hypokalemia include fatigue, proximal muscle weakness, and decreased deep tendon reflexes, as seen in this patient.
what is the presnetation of HELLP
hemolysis, elevated liver enzymes, low platelets and aterial hypertension and proteinuria
what is the presnetation of acute fatty liver of pregnancy
This patient presents in the third trimester of pregnancy with features of hemolysis (e.g., anemia, indirect hyperbilirubinemia), acute hepatic failure (e.g., right upper quadrant pain, elevated liver function tests, prolonged PT, asterixis), and acute renal insufficiency (e.g., elevated creatinine). She is at increased risk of developing disseminated intravascular coagulation (DIC).
what is the presentation of acute cholestasis of pregnancy
occurs in the third trimester and can manifest with right upper quadrant pain, nausea, vomiting, and scleral jaundice, which are seen here. this condition is characterized by intense pruritus,
what is preconception care
screening for rubella
Screening for measles, mumps, rubella, and varicella prior to conception is indicated because vaccination to obtain immunity requires live-attenuated vaccines.
