APGO Unit 2: Obstetrics Flashcards
Acid-base status during normal pregnancy?
Physiologically increased minute ventilation causes compensated respiratory alkalosis
Cause of subjective SOB during pregnancy?
Inspiratory capacity increases => increased TV => increased MV + decreased FRC (from belly) => subjective dyspnea
Predisposition of decreased plasma osmolarity?
Pulmonary edema
Causes of pulmonary edema in pregnancy?
Tocolytic use (additive risk with multiple agents)
Cardiac disease
Fluid overload
Pre-eclampsia
Affects of pregnancy on ureters
Common for ureter dilation R>L (2/2 sigmoid colon protecting left)
Right ovarian vein complex is uniquely dilated in pregnancy and overlies the right ureter
High levels of progresterone cause ureteral dilation
Thyroid hormone changes in pregnancy?
Increased estrogens => increased TBG => increased TOTAL T3 & T4 => normal FREE T3 & T4
Next step after identifying molar pregnancy?
CXR => most common site of metastasis in gestational trophoblastic disease
Heterogeneous cystic tissue (snowstorm pattern) on transvaginal ultrasound?
Molar pregnancy
Weight gain guidelines
Underweight (BMI 30): 11-20 lbs
Preconception counseling for African Americans with no significant history?
Hemoglobin electrophoresis and CBC
Increased disease incidence with Ashkenazi Jewish heritage
Fanconi anemia Tay-Sachs Cystic Fibrosis Niemann-Pick Canavan disease Bloom syndrome Gaucher disease
Defects associated with poorly-controlled DMII at time of conception?
Structural abnormalities:
Neural tube defects
Cardiac abnormalities
Uses and non-uses of CVS
Uses:
Cystic Fibrosis
Karyotype
Non-uses:
Neural tube defects
Omphalocele
What is sequential screen?
First trimester nuchal translucency + PAPP-A
Second trimester quad screen
93% detection rate
What is triple screen?
Second trimester:
AFP
B-hCG
uE3 (unconjugated estriol)
69% detection rate
What is quad screen?
Second trimester: AFP B-hCG uE3 (unconjugated estriol) Inhibin A
81% detection rate
Risk of fetal loss associated with CVS?
1%
Not related to prior miscarriages
Most common form of inherited mental retardation?
Fragile X syndrome
Down Syndrome = genetic NOT inherited
How to resolve discordant physical exam and menstrual cycle gestational dating?
First trimester obstetrical ultrasound
Quantitative B-hCG unreliable
Risk factors for gestational diabetes
Previous baby > 9 lbs
Hx of abnormal glucose tolerance
Pre-pregnancy weight of >110% of ideal body weight
Ethnic group with higher rate of DMII (e.g. American Indian, Hispanic)
Associated risks of gestational diabetes
Shoulder dystocia Metabolic disturbances Preeclampsia Polyhydramnios Fetal macrosomia
Dosing of folic acid during pregnancy
High-risk (previous neural tube defect): 4 mg/day
Low-risk: 0.4 mg/day
Malformations associated with valproate during pregnancy
Spina bifida Lumbar meningomyelocele Cardiac defects Facial clefts Hypospadius Craniosynostosus Limb defects (radial aplasia)
Protein recommendations for pregnancy
70 grams/day
What drug to give if anticoagulation needed during pregnancy?
Heparin
LMWH
Warfarin is teratogenic
True labor definition
Strong, regular uterine contractions that result in progressive cervical dilation and effacement
Braxton-Hicks contractions definition
Irregular, low intensity contractions described as lower abdominal or groin pain sometimes associated with nausea
What are labor warnings?
Contractions every 5 min for 1 hour
ROM
Fetal movement less than 10 per 2 hours
Vaginal bleeding
Risks of placing IUPC?
Placental separation and uterine perforation
What are the different decelerations and their causes?
Early decel: Head compression
Late decel: Placental insufficiency
Variable decel: Umbilical cord compression
What usually causes sustained fetal bradycardia?
Umbilical cord prolapse
Management of umbilical cord prolapse
Cesarean delivery even if fetal monitoring reassuring
Indications for episiotomy?
None
