CM 3 Flashcards
which special tests to do at 18-20 wks vs 24-28wks vs 28wks vs 36wks?
anatomy scan vs gtt vs rhogam vs gbs
what does smaller vs bigger vs >2-3cm bigger for fundal height mean?
IUGR, inaccurate dates vs polyhydramnios, multiple, macrosomia vs US
when to do fetal kick counts and how to do them? what do accels look like on NST?
28wks; water, move; 5 kicks/1hr or 10 kicks/2 hr. 10x10 <32wks, 15x15 >32wks
preecl w/ severe features. when to tx?
preecl + >/=160/110, thrombocytopenia, impaired liver, renal insuff, pulm edema, vision/cerebral disturbance. w/in 15min b/c acute OB emergency
when to give HTN meds during preg? how to ctrl severe acute HTN in preg? how to induce for preecl w/ severe features?
> /=160/105. note that all HTN meds cross placenta & reach fetal circ. labetalol, nifedipine, hydralazine. mg so4, manage bp w/ hydralazine or labetalol
what does mg so4 do? Labetalol is good for HTN but careful w/?
CCB, neuroprotection, vasodil, sz prophylaxis; give if preecl w/ severe features. Avoid in asthmatics and hypoglycemia in babies
how to manage eclampsia? how to prevent preecl?
mg for sz prophylaxis, IV HTN meds, deliver immediately. baby ASA at 12-28wks
risk factors for early spont ab <13 wks?
AMA, abnl chrm, defective implant, cvx incompetence, ut anomalies, thy/DM, teratogens
how to eval for threatened ab? how to manage spont ab?
cvx open/closed, ut non/tender; progesterone, BHCG, CBC, rhogam/type & screen, US. meds by PG or D&C
how to eval for recurrent ab? how to get septic ab vs tx vs complications?
parental cytogenetics, thy/DM screen, antiphospholipid ab, thrombophilia, sonohyst/HSG. illegal induced ab -> staph or gram neg bacilli vs broad abx, suction curettage vs PID, hem, shock
any bleed in preg should get a?
blood type for rhogam
Dx w/ amnio and PCR
Toxo and CMV
Dx with liver fxn and HBSAg. e ag has higher viral load. Key to tx is vax
HBV
Late sxs of syphilis. How to dx?
Hutch teeth, mulberry molar, saddle nose, saber shins. VDRL and TPA b/c first test can be false pos
Which dx to Doppler MCA for fetal anemia?
Parvo
Describe listeria. Key thing?
No specific foods, most infectious in 3rd trim, tx w/ PCN/Bactrim/gentamicin. PREVENTION
VZV. Rubella. CMV
1st half of preg -> congen; 5d before/2d after-> mild rash or disseminated. Oral acyclovir if rash, IVIG to baby, live vax to household contacts. Limb hypoplasia
blueberry, 3ad of sensorineural hearing loss/glaucoma or cataract/PDA, enlged lat v. dx w/ igM. Tx w/ vax
coven hearing loss, petechiae, calcifications in brain. Dx w/ amino/cx/PCR. Tx w/ antivirals
HIV in preg. Zika
Preg won’t affect HIV or vice versa, don’t BF. dx w/ ELISA & Western blot (both need be pos). Tx w/ zivoludine, don’t BF, C/S 38wks if viral load >1000
Microencephaly, dec brain parenchyma, cortical atrophy; rpt US to chk those. Dx w/ PCR of NAAT. Tx w/ prevention, no unprotected sex after 8 wks of last exposure
Biochemical hyperthyroidism vs pp thyroiditis. When does peripartum cardiomyopathy occur and w/u?
Hyperthyroid, HG, undetectable TSH, spont resolve by 18 wks vs hypothyroid, spont resolve. Last month of preg or 6mo pp; bed rest, digoxin, diuretics, possible anticoagulant; 6mo pp = marker for heart transplant; future prevention by sterilization
Acute fatty liver in pregnancy
Persistent N/V, inc liver enzymes & bili & lactic acidosis, PTL @ 35wks; tx supportive or liver transplant
How to predict PTL? Def?
Pos fetal fibronectin and cvx < 25. Ctx + cvx dil in 20-37wks
