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Leslie CNM > Antepartum abnormal > Flashcards

Antepartum abnormal Flashcards

1
Q

Transient HTN

A

BP >= 140/90 for first time w/o proteinuria if preeclampsia does not develop and the BP has returned to normal by 12 wks pp

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2
Q

Preeclampsia

A

BP >=140/90 after 20 wks GA with proteinuria (>=300mg/24hr or persistent 30mg/dL or 1+ on urine dipstick

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3
Q

Theories of etiology of preeclampsia (7)

A 
Abnormal trophoblast invasion 
Coagulation abnormalities
Vascular endothelial damage
Cardiovascular maladaptation
Immunologic phenomena
Genetic pre-disposition
Dietary deficiencies or excesses
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4
Q

Eclampsia

A

Clonic-tonic seizures before, during or up to 10 days pp that are not attributable to other causes.

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5
Q

Superimposed Preeclampsia

A

New onset proteinuria in HTN after 20 wks GA

Sudden increase in proteinuria and BP and decrease in platelets <100K in women with proteinuria before 20wks GA.

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6
Q

HELLP Syndrome

A

Hemolysis, Elevated Liver enzymes, Low Platelets

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7
Q

HTN risk factors (8)

A 
Nulliparous
New father
Adverse med hx
Fam hx of preeclampsia
Multiple gestation, fetal hydrops 
Race
Obesity
>35 y/o
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8
Q

S/S of abnormal HTN disorders (7)

A 
HTN: BP >= 140/90
Proteinuria: 30mg/dL random, 1-2+ on dipstick; >300mg/24hr
Thrombocytopenia (Platelets > 100K)
Headache (resistant to meds)
Visual distrubances
Decreased urine output
Epigastric/right upper quadrant pain
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9
Q

Management plan: Early, mild hypertension (home care) (7)

A 
Left lateral bedrest 2hrs am and pm
Daily BP checks
Daily weight
Daily urine dipsticks
Bi-weekly office visits
Daily fetal kick counts
Consult and education pt
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10
Q

Preeclamsia in-patient management (9)

A 
Bed rest
decreased environmental stimulation
24hr I&Os
Labs: 24hr urine for protein and creatinine clearance
Liver function tests (AST/ALT)
High Protein dit
NSTs bi-weekly
US if  <36 weeks ega to assess IUGR
BP q2-4hrs, routine VS and FHT  otherwise
Deliver at term
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11
Q

Eclampsia management (4)

A

Call for help (notify physician stat)
Observe seizure
Prevent injury (side rails up, turn to left side, don’t restrain)
Mag sulfate IV

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12
Q

What to do after eclampsia seizure (7)

A 
Clear airway
Oxygen 8L/min
EFM
Evaluate Contractions and labor
Examine for injury
Maternal Blood gasses, electrolytes and serum
Magnesium levels
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13
Q

CMV

A

most common congenital virus from the herpes family.

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14
Q

Clinical signs of CMV maternal (4)

A

Adenopathy
Mono symptoms
Rare fever or hepatitis
More severe if immunocompromised

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15
Q

Neonatal signs CMV (8)

A 
SGA
Microcephaly (fetal hydrops),
thrombocytopenia
petechiae
jaundice
retinitis
hyperbilirubinemia
splenomegaly
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16
Q

Long term sequelae of CMV (neonate) (5)

A 
Hearing loss (most common)
Various neurological symptoms
Mental retardation
Retinitis
Developmental delay
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17
Q

Fetal transmission by trimester

A

1st and early 2nd = more serious (eg microcephaly)

3rd trimester = fetal hepatitis and thrombocytopenia

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18
Q

Toxoplasmosis transmission

A

more likely to have transmission as pregnancy increases but severity is less
1st = 15%
2nd = 25%
3rd = 60%
May slightly increase risk of stillbirths

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19
Q

Toxoplasmosis for neonate

A 
75% asymptomatic; if symptomatic 10-12% mortality
IUGR,
Retinitis
Jaundice
hepatosplenomegaly
pneumonia
adenopathy
anemia
thrombocytopenia
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20
Q

Treatment/Management with toxoplasmosis

A

Pyrimethanine, folic acid and sulfadiazine

Prevention: No raw meat, cat litter handling, hand wash foods from contaminated soil

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21
Q

Varicella (Chicken Pox)

A

A herpes virus transmitted via arosol with perinatal transmission usually within 1st 20 weeks

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22
Q

S/S of varicella

A

Fever, chills, cough
Rash (starts maculopapular on trunk, progress to vessicles and crust)
possible development of pneumonia (with high risk of mortality
Increased risk of Preterm birth

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23
Q

Fetal congenital infection of Varicella (8)

A 
Greatest risk 13-20wks
Skin scarring
Microcephaly and micro-ophthalmia
Limb reduction
Growth restriction
Polyhydramnios
Dextrocardia
30% neonatal mortality rate if infected near birth
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24
Q

Treatment Varicella

A

acyclovir IV if symptomatic with complications

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25
Q

Rubella transmission

A

14-21 day incubation period through nasaopharyngeal secretions
1st timester exposure results in 20-80% congenital abnormalities
No documented defecte beyond 20 wks

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26
Q

Fetal s/s of rubella (9)

A 
Fetal growth restriction
Cateracts
Congenital Heart disease
Bone lesions
Hepatosplenomegaly
Congenital deafness
petechiae
anmeia
microcephaly
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27
Q

Late neonatal sequelae of rubella (5)

A 
Mental retardation
Diabetes
Thyroid disease
Visual Damage
Encephalitis
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28
Q

Management of Rubella

A

Treatment is palliative
Vaccination of children and susceptible women of childbearing age
Vaccine contraindicated in pregnancy

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29
Q

Thyroid changes in preg

A

Moderate thyroid enlargement
Fetus uses maternal iodide up to 20 wks GA
Increased maternal renal clearance of iodide
TSH does not change in pregnancy

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30
Q

Management of thyroid in preg

A

Sig increase in size, goiter or nodule requires evaluation.
ACOG: Thyroid testing only performed on symptomatic women with personal hx of the disease or other conditions associated with disease (i.e. DM)

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31
Q

Thyroid storm

A

Medical emergency: extreme hypermatabolic state with risk of maternal heart failure; s/s = fever, tachycardia, changed mental status, vomiting, diarrhea, cardiac arrhythmia

32
Q

Dizygotic twins

A

multiple ova fertilized by different sperm
2 separate placentas and 2 separate membranes
Runs in families
69% of twins
More likely in AA women

33
Q

Monozygotic twins (identical)

A

31% of twins
Data suggest small increase with ovulatory stimulants
Relationship of # of placenta/membranes depends on timing of division
monoamniotic/monochorionic
diamniotic/monochorionic
diamniotic/monoamniotic

34
Q

Maternal risks of multiple gestation (4)

A

HTN (10-25%)
Abruption (2-6%)
PP hemorrhage (10-20%)
Preterm birth (25-50%)

35
Q

Fetal risks of multiple gestation

A

Growth restriction
Preterm birth
Demise of more than one twin (more common in mono twins)
twin-twin transfusion

36
Q

Genital Warts risks in preg

A

Potential lesions on vocal chords or in the upper airway and can result in rare respiratory papillomatosis

37
Q

Management of Genital warts

A 
Immiquimod (class B) or topical TriChloractic acid
Podophyllin & podofilox are contraindicated
38
Q

HSV risks in preg

A

Neonatal infection

39
Q

HSV management in preg

A

C/S if active lesion or prodromal symptoms at onset of labor

Prophylaxis with acyclovir in last month of pregnancy

40
Q

Gonorrhea risks in preg

A

Neonatal blindness

41
Q

Gonorrhea management in preg

A

Neonatal prophylaxis at birth

maternal tx Ceftriaxone 250mg IM once

42
Q

Chlamydia risks in preg

A 
Opthalmia neonatorum (not liked to blindness) 
Neonatal pneumonia (tx during preg may reduce risk)
43
Q

Chlamydia management in preg

A

Azithromycin 2g one time dose (maternal)

Neonatal eye prophylaxis at birth

44
Q

Syphilis risks in preg

A

Congenital syph: cataracts, microcphaly, hutchinson’s teeth (notched teeth), hepatoslenomegaly

45
Q

Management of Syphilis in preg

A

Treat ASAP to minimize neonatal effects
Treat as latent (3 injections of benzathine penicillin 1 each week for 3 wks).
If allergic, desensitize with PCN, cuz erythromycin has poor placental crossing (woman may be treated, but not fetus)

46
Q

HIV risks in preg

A

Perinatal transmissions may occur esp with vaginal birth or BF if viral load is not suppressed.

47
Q

Management of HIV in preg

A

Antiretroviral therapy during preg and neonatal periods
C/S recommended if viral load is not suppressed
No BF

48
Q

Bleeding in preg how often and how is it related to SAB

A

25% of women in 1st and 2nd trimesters will experience bleeding and approximately 13% or half will experience SAB
ABs, Moles, ectopics, blighted ovums

49
Q

Def of Threatened AB (4)

A

Continuation of preg is in doubt
Does not always culminate in AB
Usually pain is absent of minimal; if present, it is an ominous sign.
The cervix is closed and not effaced

50
Q

Inevitable AB (3)

A

Termination of preg is in progress
Usually characterized by dilated cervix with accompanying pain, bleeding or rupture of membranes
Inevitable abortion usually proceeds to complete or incomplete AB

51
Q

Incomplete AB

A

Products of conception protrude through the cervical os

Bleeding is apt to be more severe than other types of abortions often necessitating a D & E

52
Q

Missed AB

A

Fetal death occur w/o expulsion of POC for several weeks
Bleeding may or may not occur and may be light if it does
Uterus is smaller than expected

53
Q

Blighted ovum (no embryo)

A

Unknown etiology
Gestational sac develops, but no embryo
Usually treated as inevitable or incomplete abortion

54
Q

Ectopic Preg

A

Preg outside the uterine cavity

usually assoc with pain, irregular bleeding and possible adenexal mass or fullness on one side

55
Q

Gestational trophoblastic disease (molar preg)

A

Abnormal chorionic villi that form grape like vessicles, may occur with fetus (incomplete mole) or in absences of a fetus (complete mole)
Uterus large or small for dates.
No FHT if complete mole
Assoc with early preeclampsia, hyperemesis gravidarum and very high HCG levels
May progress to invasive mole or choriaocarcinoma

56
Q

Incomplete mole & complete mole

A

IM =May be result of fertilization with diploid sperm

CM = only paternal genetic material, possibly from 2 sperm fertilizing an ovum with no maternal genetic material

57
Q

Other reasons for bleeding in preg (more gyne related)

A

Chlamydia, cervical eversion causing more postcoital bleeding and with paps and cervical polyps

58
Q

Normal HCG levels in preg

A

rises 66-100% every 48 hrs until about week 8; rises slowly until week 10 and plateaus at 24 weeks

59
Q

HCG in abnormal conditions (3)

A

Ectopic: < 66%/48hrs
GTD (mole): higher than expected
SAB (complete): <5 mIU/mL or less; may take several weeks to go down

60
Q

Bleeding in late preg (6)

A

Previa (20%)
Abruption (30%)
Other Causes (50%)
Marginal placental separation, preterm labor, STI

61
Q

Hypertonic uterus =

A

more likely due to abruption

62
Q

Transvag US is best for identifying what condition

A

Preveia
Placental abruption (inconsistently identifiable)
No pelvic exam if previa

63
Q

Emergency late preg bleeding

A

Emergency consult and obtain neonatal support if

  1. Brisk vaginal bleeding
  2. unstable vital signs
  3. Fetal distress
64
Q

management of bleeding in late preg

A

maternal O2,
Trendelenburg position or at least pelvic tilt
Immediate IV access: 2 large bore IV (16-18 gauge)
Initiate IV LR solution
Order type & Cross 2 units of whole blood.

65
Q

Post dates complications

A 
Maternal= Birth trauma due to macrosomia/shoulder dystocia, increased incidence of operative delivery, secondary infection or hemorrhage
Neonatal= Meconium aspiration syndrome, polycythemia, hyperbilirubinemia, hypoglycemia
66
Q

Fetal surveillance postdates per ACOG

A

Despite lack of evidence that monitoring improves outcomes, its reasonable to initiate fetal surveillance between 41 and 42 wks GA with NST and AFI, performed biweekly

67
Q

Asthma in preg: Patient outcomes

A

28% improve; 33% no effect; 35% worsen

Consultation or collaboration is necessary depending on severity

68
Q

Maternal complication with asthma in preg (5)

A 
Hyperemesis
Preeclampsia
CHTN
Vaginal bleeding
Preterm labor and birth
69
Q

Management of Asthma in preg (6)

A

Careful observation of fetal size
Fetal kick counts
Continue peak flow diary
Condition likely to worsen at 29-36 wks GA
Avoid beta adrenergics; use of Mag SO4 controversial for PTL

70
Q

Acute treatment in preg (8)

A 
Admit if peak flow is 95%
Continuous pulse ox
EFT
Pulmonary function tests
Beta Adrenergics
Mortality >40% if asthma requires intubation
71
Q

GDM causes

A

Preg is a diabetogenic state due to fasting hypoglycemia, post prandial hyperglycemia and hyperinsulinemia.
hPL decreases insulin effectiveness
Progesterone thought to increase basal levels of insulin
Progesterone and Estrogen thought to have a role in increasing tissue resistance to insulin
In GDM mother cannot produce enough insulin to overcome peripheral insulin resistance

72
Q

Screening for GDM

A

Average risk: at 24-28 wks GA
High risk: at first visit and repeat at 24-28wks GA.
ACOG recommend all preg women be screened by pt hx, clinical risk factors or 1hr GTT at 24-28wks

73
Q

3hr GTT cut offs

A 
Fasting >105
1hr >190
2hr >165
3hr >145
GDM diagnosed when 2 or more are over the cut off.
74
Q

PROM and PPROM

A

Spontaneous ROM prior to onset of regular uterine contrx. PPROM if earlier than 37 wks GA
Assoc w/ complications such as PTL, chorio, prolapsed cord and malpresentation
The earlier in preg PROM occurs the longer the latent period (time b/t rupture and contrx)

75
Q

Causes of PROM

A

Infection (bacteria weaken collagen in membranes and initiate prostaglandin synthesis)
Usually BV, Trich, GC/CT and GBS

76
Q

Mgmt of PROM (induction vs expectant)

A 
Induction = shortens latent period, avoid unnecessary vag exams, watch for s/s of infection
Expectant = the longer latent period > chance of infection; 70% go into labor in 24h and 90% in 48hr; sterile spec exam, fetal kick counts, temps every 4 hrs, NST or BPP every 2 days; BPP <6 may mean amniomitis; pelvic rest
77
Q

Mgmt of PPROM

A

Amnio to detect infection and assess fetal lung maturity; abx therapy; moreso expectant mgmt; admin of corticosteroids; prolong preg to 34 wks in absence of infection and fetal distress

Leslie CNM (7 decks)

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