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OB/GYN > Case Files > Flashcards

Case Files Flashcards

1
Q

What’s needed to make formal diagnosis of preeclampsia?`

A

after 20 weeks gestation, 2 elevated BP readings 6 hours apart.

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2
Q

Complications of preeclampsia

A

placental abruption

ecalmpsia with possible intracerrebral hemorrhage

coagulopathies

renal failure

hepatic subscapular hematoma

hepatic rupture

uteroplacental insufficiency

Fetal growth restriction

Oligohydramnios

low APGAR score

fetal acidiosis

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3
Q

Risk factors for preeclampsia

A

nulliparity

extremes of age

AA race

personal hx of severe preE

fam hx of preE

chronic htn

chronic renal disease

obesity

antiphopholipid syndrome

DM

multifetal gestation

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4
Q

when to evaluate BP in pregnancy?

A

befre and after 20 weeks–do serial bp readings along with urinalysis.

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5
Q

sudden increase in weight in pregnany can indicate what?

A

edema

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6
Q

Lab tests to order for PreE

A

CBC – check platelet count and hemoconcentration

Urinalysis and 24 hour urine protein collection

liver function tests - CMP

LDH and uric acid

**BPP for uteroplacental insufficiency.

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7
Q

Management of PreE in GA >37wks

A

Mag sulfate and deliver

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8
Q

Management of PreE in preterm, GA <37

A

Watch closely and expectant management if mild PreE until term or severe

-If severe disease present then give mag and deliver

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9
Q

when is the greatest risk of Eclampsia in a preeclamptic patient?

A

prior to delivery

during labor (intrapartum)

within the first 24 hours postpartum.

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10
Q

If patient given magnesium, what needs to be monitored?

A

urne output bc it’s excreted renally

respiratory depression and dyspnea (side effect f mag is pulm edema)

abolition of deep tendon reflexes (frst sign of toxic effect is hyporeflexia)

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11
Q

What htn meds given to pregnant patients?

A

hydralazine or labetalol.

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12
Q

when is mag discontinued?

when should preeclamptic patients f/u after delivery?

A

approx. 24 hours postpartum.

f/u 1-2 weeks to check bp and proteinuria.

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13
Q

early vs late onset preE?

A

early onset may be due to abnormal placental factors–see nothcing of uterine artery on doppler. These patients have worse and earlier onset disease

late onset d/t constitutional factors like obesity. These pts have a more favorable course. Bariatric surgery prior to pregnancy in obese pts can help reduce risk of preE and the risks of obesity

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14
Q

Ddx in abnormal LFTs in pregnancy?

A

preeclampsia- LFTs 100-300 IU/L range, htn, proteinuria

AFLP- n/v, icteric, hypoglycemia, coagulopathy

HELLP- hemolysis, lfts up to 1000 IU/L, plt <100k uL

ICP- generalized itching, mildly elevated LFTs, elevated bile salts.

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15
Q

MC mechanism by which eclampsia causes mortality?

A

intracerebral hemorrhage

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16
Q

preterm patient with mild preE, management?``

A

expectant management until severe criteria noted or pregnancy reaches term.

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17
Q

most appropriate reason for delivery in preE at preterm gestation?

A

pulmonary edema.

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18
Q

Preterm labor workup

A

hx ass for risk factors

PE with speculum for ruptured membranes

serial digital cervical exams

CBC

UDS

UA, U CULTURE AND SENSITIVITY

cervical tests for gonnorhea and possibly chalm

vag culture for GBS

US for fetal weight and presentation

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19
Q

vaginal fluid test increase risk for preterm delivery ?

other objective test for preterm delivery?

A

fetal fibronectin assay. Negative FFN indicate that delivery will not occur within 1 week.

  • transvaginal cervical length US measurement.
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20
Q

most significant risk factor for preterm labor?

A

hx of prior spontaneous preterm birth

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21
Q

Tx for preterm labor

A
  • tocolysis unless contraindicated (intraamniotic infection or severe preE)
  • IM antenatal steroids if less than 34 weeks for fetal pulmonary maturity
  • cause of preterm labor such as UTI, infection ,bv
  • IV ab like penicillin
  • if less than 31 and 6/7, then give mag for neurodevelopment of preterm baby reducing CP.

-

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22
Q

tocolytic agents used?

A

mag- Competitive inhibitor of calcium

terbutaline/ritodrine - beta agonist- relax smooth muscle

nifedipine - inibt ca ion influx into vascular smooth muscle

indomethacin - decrease prostaglandin synthesis

17alpha pregogesterone - synthetic progesterone hormone – give 16-36 weeks to prevent preterm labor in people with hx of preterm labor.

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23
Q

Side effects and contraindications to tocoltic agents?

A

mag- pulm edema side effect

terbutaline/ritodrine- pulm edema, increase puplse preesure, HYPERglycemia, HYPOkalemia, and trachycardia side effect

nifedipine- HTN is a contraindication. dont give mag sulfate with it

indomethacin- dont give in third trimester– close fetus ducuts arteriosus which would lead to pulm htn and oligohydramnios.

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24
Q

is gonorrhea or chalmydia or both associated with preterm delivery?

A

gonoccoal cervicitis but not so much chalmydial infection.

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25
Q

What’s a contraindication for tocolysis and why?

A

abruption bc it can extend and cause complete shearing of placenta in which case delivery would bethe best treatment.

Tocolysis would increase the motehr’s chance of hemorrhage after delivery.

26
Q

change in fetal heart rate tracing after tocolysis showing variable decels?

A

variable decels = cord compression

can occur in oligohydranios

indometahacine is assocated oligohydramnios

27
Q

side effect of many tocolytic therapy esp beta agonists?

Tx?

A

pulmonary edema.

Tx- Oxygen and IV furosemide to decrease intravascular fluid.

28
Q

PPROM management?

A

in the absence of infection give corticosteroids to decrease risk of RDS.

broad spectrum antibiotics to decrease risk of asending infections.

aka expectant management

29
Q

pprom–> expectant management –> chorioamnionitis. tx?

A
  • give IV antibiotics such as ampicillin and gentamicin

and

induction of labor and vaginal delivery

30
Q

early isgn of chorio?

A

fetal tachycardia.

31
Q

when should antenatal steroids be given for pprom?

A

before 32 weeks gestation

32
Q

for PPROM when is delivery the treatment after expectant management?

A

34/35 weeks

or if evdece of fetal lung maturity by presence of phosphatidyl glycerol (PG) in the vaginal pool amniotic fluid.

33
Q

most accurate methd to confirm intra-amniortic infection?

A

amniocentesis revealing organisms on gram stain are diagnostic of infection

34
Q

what organism can induce chorioamnionitis w/o rupture of membranes?

organisms most likley affecting neonates?

A

chorio w/o ROM– b. listeria

  • fbs and gram neg enteric orgs like e coli are most common orgs to affect neonates
35
Q

most common finding with PPROM?

A

variable decels bc of oligo –> cord compression

tx with changing the patient’s position.

36
Q

difference in parvo b19 infection in adults and childre

A

adults- malaise, arthralgia, myalgia, reticular/lacy rash

children- slapped cheek with high fever

37
Q

what kind of organism is parvo b19?

infection in pregnancy can cause?

how to diagnose parvo b19 infection?

A

SS DNA virus.

infection in pregnancy can cause hydrops fetalis d/t severe fetal anemia since it inhibits bone marrow erythrocyte production

diagnose with serology

38
Q

FHRT in severe fetal anemia?

A

sinusoidal HR pattern

39
Q

signs of fetal hydrops?

how to confirm?

A

excess hydramnios –> uterine size greater than predicted by dates and fetal parts that are difficult to palpate.

confirm with US

40
Q
  • igm and igg both negative for parvo?
A
  • if more than 20 days then suscpetible but not infected –> counsel and stay away from infected places
  • if less than 20 days then possible early infection vs not infected –> repeat igg and igm in 1-2 weeks.
41
Q

how to follow pregnant women infected with parvo b19?

if hydrops?

A

weekly fetal US for 10 weeks assessing for fetal hydrops.

if hydrop then intrauterine transfusion may be necessary.

42
Q

is there a vaccine for parvo b19?

A

no!

43
Q

parvo 19 infection complications?

A

fetal abortio, stillbirth and hdyrops.

44
Q

ways to assess for possible fetal anemia?

result?

A

fetal MCA doppler and if anemia it’ll show elevated systolic veolocity.

45
Q

mcc of nonimmune hydrops?

A

cardiac abnormalities like SVT but doesnt affect bone marrow,.

46
Q

fetal dudenal atresia diagnosis?

A
  • double bubble on US a/w hydramnios.
47
Q

chlamydia test positive next step?

A

oral erythromycin, azithromycin or amoxicillin

48
Q

screening and diagnostic test for HIV test?

A

screening test : ELISA or rapid antigen test

diagnostic: western blot or an IFA.

49
Q

treatment of HIV in pregnancy?

A
  • assess stage of HIV infection

initiation of HAART

offer elective C section

oral zidovudine to neonate

50
Q

is chalmydia or gonorrhea infections more common?

A

chlamydia!

51
Q

complications of chlamydial infection in pregnancy?

tx?

A

conjunctivitis and pneumonia.

conjunctivitis: erythromycin eye ointment DOES NOT HELP–only helps in gonorrheal conjunctivitis. Chalmydial ophtlamic infections given ORAL ERYTHROMYCIN X 14 days.

52
Q

when to screen for chlaymidia?

tx?

A

third trimester since e’re worried about it affecting neonate so close to time of delivery is when we want to check.

Tx with erythromycin or amoxicillin x 7 days

OR

1 time dose of azithromycin

53
Q

which antibiotics is contraindicated in pregnancy and why?

A
  • tetracycline like doxy can cause fetal teeth yellow staining
  • cipro associated with neonatal musculoskeletal problems
54
Q

what kind of organism is chlaymida?

A

obligate intracellular organism with several serotypes.

55
Q

MCC of conjunctivitis in first month of life?

A

chlamydial conjunctivitis

56
Q

gonococcal infection associated with?

A

abortion, preterm labor, PPROM, chorio, neonatal sesis, and postpartum infection.

57
Q

Tx of gonococcoal cervicitis?

A

IM ceftriaxone and add erythromycin bc c. trachomatis is commonly infected with it

58
Q

when should antibodies for HIV detected?

A

1 month usually and def 3 months

59
Q

how to monitor health status of HIV infected preggo woman?

A

viral load and CD4 T cell tesing

60
Q

whats the goal in pregnancy in term of viral load for HIV?

A

under 1000 RNA copies

61
Q

MC mode of HIV transmission in women?

A

heterosexual contact

seen esp in AA women.

62
Q
A

OB/GYN (2 decks)

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