Clinical Applications of Pregnancy I - Westra Flashcards
What does screening for gestational diabetes include?
24-28 weeks (if asymptomatic, otherwise test earlier)
Screening 50-g one-hour glucose challenge (drink/14 jelly beans): >130 mg/dL test is a positive screening test
Diagnostic 100-g three-hour oral glucose tolerance test (Fasting 90, 1 hour 165, 2 hour 145, 3 hour 125); Two or more abnormal values are considered diagnostic for gestational diabetes
What are the signs of pre-term labor?
Cervical change associated with uterine contractions prior to 37 weeks
In nulliparous woman, uterine contractions with 2+ cm dilation and 80% or greater effacement
What are the risks of rubella infection during pregnancy?
Rubella: CRS –congenital rubella syndrome – deafness, cardiac abnormalities, cataracts, mental retardation
What is the differential diagnoses for antepartum bleeding?
Worst case scenaria: Placental abruption (painful contractions)
Complete/Partial Placenta Previa (painless bleeding)
Marginal placenta previa: placenta abuts against the internal cervical os
Low lying placenta: edge of placenta is within 2-3 cm of the internal cervical os
Vasa previa: Umbilical cord vessels that insert in the membranes with the vessels overlying the internal cervical os, vulnerable to fetal exsanguination upon rupture of the membranes
What do abnormal fetal presentations look like?
Face presentation / Chin presentation / Brow presentation
Breech presentation (complete- legs flexed, incomplete- one leg flexed, frank- legs extended)
Shoulder presentation
Prolapsed Umbilical Cord (cord in cervix)
Why is gestational diabetes concerning?
After 12 weeks gestation, maternal glucose crosses the placenta and fetal beta cells can produce insulin. If maternal glucose level is elevated after 12 weeks gestation, fetal insulin production increases. The growth hormone effects of this insulin lead to fetal macrosomia.
20% of deliveries of women with GDM are macrosomic (>4000 grams-8# 13 oz)
What are the risk factors for Gestational DM?
35 years and older
BMI greater than 25 kg/m2
Family history of DM in first degree relative
History of previous gestational diabetes
Macrosomia in previous pregnancy
High-risk ethnic group (Hispanic, Asian, Native American, African American, Pacific Islander)
What is the reasoning behind the Fetal Fibronectin Assay in the setting of preterm labor?
Large glycoprotein thought to act as adhesive of fetal membranes to decidua
Better predictive value than cervical dilation or uterine activity in predicting imminent delivery
High negative predictive value
FN negative 1/125 deliver in 14 days
FN positive 1/6-1/3 deliver in 14 days
What is the treatment for preterm labor?
Treatment of possible causes
Corticosteroids to improve fetal outcomes
Antibiotics for prophylaxis of GBS infection
Limited Tocolysis (Nifedipine)
Emergency cervical cerclage
Psychosocial support
How do you treat a pregnant woman with GC/Chlamydia infection?
Oral Erythromycin, Azithromycin or amoxicillin
How do you treat a pregnant woman with newly diagnosed HIV?
Confirm HIV with western blot
Optimal treatment of HIV infection in pregnancy: initiation of highly active antiretroviral therapy (HAARTP) offer C-section near term.
Oral zidovudine (ZDV) to the neonate
Unborn fetus may become infected by transplacental passage or during the delivery process.
The neonate may acquire HIV from infected breast milk
Goal in pregnancy is to maintain a viral load of less than 1000 RNA copies per milliliter
Polytherapy to decrease resistance
What is the work up and treatment for antepartum bleeding?
***Ultrasound first (see where placenta is)
Speculum exam
Stabilize the patient
Prepare for the possibility of future hemorrhage
Prepare for preterm delivery
Deliver if bleeding is life threatening or fetal testing is non-reassuring
What are the risk factors for placenta previa?
Grand multiparity Prior cesarean delivery Prior uterine curettage Previous placenta previa Multiple gestation
What are the Predisposing/Precipitation Factors for Placental Abruption?
Hypertension Advanced maternal age Multiparity Multiple pregnancy Diabetes Mellitus Trauma External/internal version Delivery of first twin Rupture of membranes with polyhydramnios
