Clinical pearls Flashcards
How do you calculate day of delivery?
Nagele rule: LMP - 3 months + 7 days
At what B-hcg level can you see pregnancy on US?
Beta-HCG > 1500 = 5 weeks
When is digital vaginal exam contraindicated?
third trimester bleeding because it may lead to increase separation between placenta and uterus resulting in severe hemorrhage
In what types of patients are prostaglandins contraindicated?
asthmatics because it may provoke bronchospasm
How does Sheehan syndrome present?
Inability to breastfeed
What defines adequate uterine contractions?
greater than 200 Montevideo units
contractions every 2-3 mins lasting 40-60 secs
What drugs induce hemolysis in patients with G6PD deficiency?
sulfonamides, nitrofurantoin or antimalarial agents
What is the most common cause of inverted uterus?
undue traction on the cord when the placenta has not yet separated
What is the most common complication of inverted uterus?
hemorrhage due to uterine atony
What is McRoberts manuever and when do you use it?
flex maternal thighs against abdomen. this rotates the symphysis pubis anteriorly toward maternal head.
use for shoulder dystocia
What are the causes of elevated AFP?
underestimation of gestational age multiple gestations neural tube defects cystic hygroma fetal skin defects sacrococcygeal teratoma decreased materal weight oligohydramnios
What are the causes of low AFP?
Overestimation of gestational age chromosomal trisomies molar pregnancy fetal death increase materal AFP
Trisomy 21
low AFP low uE3 high hcg high inhibin A low PAPP-A
Trisomy 18
low AFP
low uE3
low hcg
low PAPP-A
Trisomy 13
low PAPP-A
low B-hcg
What kind of pain is typical of ovarian torsion?
Acute onset of colicky abdominal pain that is episodic at 14 wks or after delivery
If corpus luteum is excised less than 10-12 was what should be supplemented?
Progesterone
What causes pruritis with or without jaundice and no skin rash? When does it begin? What is the complication?
Intrahepatic cholestasis of pregnancy (ICP)
Begins in third trimester
Perinatal mortality
what is the earliest sign of chorioamnionitis?
fetal tachycardia
what does a negative cervical fetal fibronectin assay indicate?
guarantees no delivery within 1 week
what is the first sign of mag toxicity?
loss of deep tendon reflexes
what is the difference between chronic htn and gestational htn?
chronic: htn prior to 20 wks gestation or if htn persists beyond 12 wks postpartum
gestational: htn after 20 weeks without proteinuria
what medications are used to treat chlamydia in pregnancy?
oral erythromycin, azithromycin or amoxicillin.
doxycycline is contraindicated because it can cause teeth staining
What is the cause of post partum hyperthyroidism?
lymphocytic thyroiditis due to flare of autoimmune antibodies after corticosteroid levels drop post partum. check antimicrosomal and antiperoxidase antibodies
What are the TSH, free thyroixine, TBG, and total thyroixine levels in hypothyroidism?
TSH - increased
free thyroixine - decreased
TBG - increased
total thyroixine - unchanged
How does pregnancy affect thyroid levels?
due to increase estrogens TSH - unchanged free thyroixine - unchanged TBG - increased total thyroixine - increased
What is the difference between cause of symmetric and asymmetric IUGR?
symmetric is caused by aneuploidy or early transplacental infection.
asymmetric reflects a more recent insult to fetal growth like htn
What is diagnostic criteria for diabetes in pregnancy?
ph 200
Bicarbonate
what does fluctuance in the breast indicate?
abscess
What is the treatment for post partum mastitis?
dicloxacillin and cont breast feeding
what is the most common cause of fever after cs? What is the organism that causes it?
endomymometritis
Bacteroides
what is pregestational diabetes associated with?
congential anomalies and miscarriages
What hormones in pregnancy cause insulin resistant state?
CRH, hPL, progesterone
