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OB > Common problems of pregnancy-Table 1 > Flashcards

Common problems of pregnancy-Table 1 Flashcards

1
Q

Where are the areas most commonly affected by striae (stretch marks) during pregnancy?

A

Abdomen, thighs, breast

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2
Q

What is raccoon face?

A

Mask of pregnancy, melasma, cholasma
Hyperpigmentation of skin on forehead, upper lip, and cheeks caused by the steep rise in estrogen levels, which stimulate excess melanin
Should go away

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3
Q

what is PUPPP?

A

Pruritic urticarial papules and plaques of pregnancy

Itchy, raised rash most commonly appearing on the abdomen, thighs, arms, and butt

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4
Q

When is PUPPP more common?

A

Third trimester and in moms carrying multiple fetus’s

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5
Q

What are tx options for PUPPP?

A

Emollient creams, OTC antihistamine, compress etc

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6
Q

What are tx options for striae?

A

Creams, laser tx…all kinda depends

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7
Q

What is the rule of 3 in regards to asthma during pregnancy?

A

1/3 of women… get better, get worse, or stay the same

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8
Q

When should a serial US and antenatal testing be done in pregnant asthmatics?

A

At >/= 32 weeks to make sure baby is receiving enough O2

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9
Q

If HTN is present before 20 wks GA, is it caused by pregnancy?

A

NO, most likely chronic HTN and unrelated

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10
Q

What is hypertensive dz of pregnancy and when does is manifest?

A

Types of htn dz: Preclampsia, eclampsia, HELLP syndrome (severe pre-eclampsia)
After 20 wk GA

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11
Q

What is a common maternal arrhythmia? What do you need to rule out if this is present?

A

Paroxysmal atrial tachycardia (PAT)

r/o underlying pathology vs secondary strenuous exercise

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12
Q

When does peri-partum cardiomyopathy kick in? how long does it last?

A

Last month through the first 6 mo pp

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13
Q

What are the S/S of peri-partum cardiomyopathy?

A

fatigue, palpitations, nocturia, ankle edema, DOE, SOB/supine

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14
Q

How is peri-partum cardiomyopathy tx?

A

Tx the heart failure and hope heart returns to normal size….

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15
Q

Why does physiologic anemia happen in pregnancy?

A

d/t dilution effect on increasing plasma volume in greater amount than increasing RBC

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16
Q

What is in PN vitamins that helps to prevent iron def anemia?

A

60-65mg elemental iron

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17
Q

What should you make sure to remind mom about when giving ferrous sulfate tablets?

A

Black poops!

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18
Q

Why is folate supplementation so important in pregnancy?

A

To prevent NTD

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19
Q

When does the neural tube form?

A

5-6weeks GA

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20
Q

What are the types of NTD?

A

Spina bifida, encephalocele, anencephaly

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21
Q

What is a cyst containing only meninges with an intact neural tube?

A

Meningocele

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22
Q

What is myeloschisis?

A

Neural groove open at one or several thoracolumbar levels

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23
Q

What is the dome shaped cyst frequently at the lumbar level that can contain neural, leptomeninges, and glial tissue?

A

Myelomeningocele

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24
Q

What constitutes spina bifida occulta?

A

vertebral arches unfused & underdeveloped, vertebral canal is open but meninges & spinal cord in canal, site covered w/skin

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25
Q

What hx might your preggo lady present with if she is being evaluated for materal sickle cell disease?

A

pre-existent underlying organ dysfunction, prior multiple transfusions, VTE, spleen status, iron storage, acute chest syndrome

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26
Q

What are the fetal risks of maternal sickle cell disease?

A

utero-placental insufficiency, alloimmunization, asymmetric IUGR, anemia, stillbirth, opioid exposure/withdrawal

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27
Q

How is maternal sickle cell disease managed?

A

Materal-fetal and hem consutl/specialist
D/C: hydroxyurea, chelating agents and ACEI- cant use these if preggo
Switch to low dose ASA after 1st trimester or LMWH during and post partum if they have a hx of VTE

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28
Q

What should be done if preggo with maternal sickle cell disease has a vaso-occlusive episode?

A
  • O2, opiod analgesia, fluids, and transfusion
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29
Q

What should be drawn monthly in maternal SCD?

A

Cbc to check ferritin level

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30
Q

What can happen to the tooth enamel during pregnancy?

A

Erosion from vomit
Use fluoride toothpaste and don’t brush immediately after
Can use 1 tsp baking soda in 8 oz water & rinse = neutralize acid

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31
Q

When does gingivitis occur in preggos?

A

2-8th mo

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32
Q

What are symptoms of gingivitis?

A

Bleeding w/brushing, erythema, mild tenderness

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33
Q

What is periodontitis?

A

Severe gingivitis involving the bone

Tx with abx, deep root scaling

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34
Q

What is a non-tender erythematous smooth/lobular growth at gumline?

A

Epulis gravidarum , aka pyogenic granuloma

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35
Q

What is the cause of pyogenic granuloma?

A

Benign Response to irritation from poor oral hygiene, tartar or trauma

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36
Q

When does pyogenic granuloma appear?

A

> /= 2nd trimester and recurrence is common

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37
Q

What are guidelines for normal weight gain n preggo?

A 
•Normal wt. 25-35 lb
•Under wt prior to conception 28-40 lb
•Over wt. prior to conception 15-25 lb
•Obese  11-20 lb
•Twins
–Normal wt. 37-54 lb
–Over wt. prior to conception 31-50 lb
–Obese  25-42 lb
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38
Q

When does morning sickness tend to happen?

A

Weeks 4-14, peaks weeks 7-12

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39
Q

How can you help adjust things to minimize or help morning sickness?

A

Small frequent meals, ice chips, ginger, B6, take PN vitamin at might with food or in different form
If severe Doxylamine succinate & B6 (Diclegis)

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40
Q

What are s/s of hyperemesis gravidarum?

A

Wt loss > 5% pre-pregnancy value

-Protracted vomiting, dehydration, ketonuria

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41
Q

What do you need to r/o with hyperemesis gravidarum?

A

Acute fatty liver of pregnancy

Appendicitis!

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42
Q

How is hyperemesis gravidarum tx?

A

IV hydration

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43
Q

If a pregnant woman gets appendicitis, where might the organ displace to?

A

Upward and laterally

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44
Q

What are symptoms and treatment for cholelithiasis?

A

F/V, RUQ pain
–Supportive: IV fluids, NG tube, analgesia
–Surgical w/obstruction or acute abdomen

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45
Q

What is Intrahepatic cholestasis of pregnancy?

A

Build up of bile acids in the liver

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46
Q

What are risk factors for Intrahepatic cholestasis of pregnancy?

A

Multi-fetal gestations, previous liver damage and or prior IUP with cholestasis

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47
Q

What is often the only symptom in Intrahepatic cholestasis of pregnancy?

A

Pruritus, esp in hands and feet

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48
Q

What are some other symptoms you should keep an eye out for in suspected Intrahepatic cholestasis of pregnancy?

A

dark urine color (like dark brown), light color BM, fatigue or exhaustion, loss of appetite, depression

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49
Q

How is Intrahepatic cholestasis of pregnancy tx? What needs to be monitored in mom?

A

Ursodeoxycholic acid

Monitor: serum bile and LFTs of mom and check non stress test in baby to check fetal HR

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50
Q

What are the most common traumas in pregnancy

A

MVA and DV/IPV (partner violence)

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51
Q

What are common outcomes of trauma in pregnancy?

A

Placental abruption, PROM, preterm labor, fetal-maternal hemorrhage, uterine rupture, maternal &/or fetal death

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52
Q

how are traumas managed?

A

Maternal stabilization and fetal US and electronic monitoring 2-6 hrs post trauma continuing for 24 hrs

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53
Q

How is the Rh status determined and assessed in trauma?

A

Kleihauer-Betke test

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54
Q

What is Asymptomatic bacteriuria?

A

Bacterial colonies on urine culture, commonly ecoli but no symtpoms are caused, can monitor and do periodic cultures without tx

55
Q

What is the sequelae of Asymptomatic bacteriuria?

A

Cyctitis and UTI and pyelonephritis

Can do abx for 3 days and 7-10 days if high risk

56
Q

What needs to happen if a pregnant women has pyelonephritis?

A

Hospital…. Risk of premature labor

57
Q

What are s/s of calculi? How should they be tx?

A

CVA tenderness, microhematuria, malaise, dehydration, no fever
Rx: hydrate, strain urine, watch for infection or obstruction

58
Q

What should you do if your pregnant pt is epileptic?

A

Send to neuro, have OB-neuro management…. No good DOC need more folate supplementation and more fetal monitoring

59
Q

What is a very common disorder in pregnant women that completely resolves postpartum?

A

Carpal tunnel…late 2-3rd trimester

60
Q

What are risk factors for antenatal depression?

A

unplanned/unwanted IUP, socioeconomic stressors (limited social network, relationship discord/DV/IPV, drug use); Hx current/past treatment depression, hx post-partum depression/blues or psychosis, FHx

61
Q

What are the post partum (PP) blues attributed to?

A

Hormonal changes…. High levels during labor and delivery followed by large decrease within 48 hrs

62
Q

When do pp blues tend to happen?

A

2-4days post birth, peaks at 5 days then resolved with in 2 weeks

63
Q

What are the symptoms of pp blues?

A

Weepy, sad, lack of concentration, anxious, irritable all coming and going

64
Q

What is PP depression?

A

More severe than PP blues, less serve and more prevalent that PP psychosis
Form of major depression

65
Q

What is the major risk factor for PP depression?

A

Antenatal depression

66
Q

What are symptoms of PP depression?

A

depressed mood, anhedonia (not enjoying baby), changes in sleep/appetite, crying spells, feeling guilty/worthless, fatigue, difficulty concentrating, interference w/ADLs & infant care

67
Q

What are risk factors of PP psychosis?

A

preexisting bipolar or schizophrenia

68
Q

What are symptoms of PP psychosis?

A

confusion, hallucinations, delusions, depressed mood, mania, disorganized thinking

69
Q

What should be done immediately if PP psychosis is suspected?

A

Inpatient tx

70
Q

When might you want to get TSH levels in a pregnant woman?

A
  • Personal/FHx thyroid dz
  • > 30 y/o; symptomatic for thyroid dz or have goiter
  • Hx preterm delivery or SAB
  • Hx H&N radiation or thyroid surgery
  • Take amiodarone or lithium
  • Infertility
  • Iodine deficient
71
Q

If your pregnant pt has stable hypothyroidism, when should you be monitoring TSH?

A
  • at confirmation of pregnancy

- then q4 weeks for the 1st 20 weeks, then once in both 2nd and 3rd trimester

72
Q

If taking thyroid meds and PN vitamins, do you need to give any education to your pts?

A

Yes, separate the PN vitamins and thyroid meds by 6hrs

73
Q

What are maternal risks for non-euthyroid hyperthyroidism?

A

HF, uncontrolled HTN, atrial fib, thyroid storm; fetal hyperthyroid in mother w/Graves’ dz

74
Q

What are s/s symptoms of graves in preggo pts?

A

fever, tachycardia, altered MS, V/D, arrhythmia thyroid storm: emergent admission !!!can lead to shock coma and death

75
Q

What are the medical rx for stable hyperthyroid in preggo?

A
  • 1st trimester: propylthiouracil (PTU) - ADE hepatotoxicity

* 2nd & 3rd trimesters: switch methimazole (MMI) & avoid fetal scalp defects/aplasia cutis in 1st trimester

76
Q

What is a teratogen that leads to the most anomalies in the first 42 days of gestation?

A

Glucose!!! Mom needs tight glucose control if DM I and preggo!

77
Q

What is the metabolic characteristic of GDM?

A

insufficient insulin secretion to counteract pregnancy related fall in insulin sensitivity

78
Q

What is happening in GDM?

A

maternal pancreas produces as much insulin as possible but can’t overcome effect of HPL elevated maternal glucose d/t dec’d peripheral uptake

79
Q

What 2 things happen to the fetus that lead to macrosomia and neonatal hypoglycemia in GDM?

A

Fetal hyperglycemia and increased fetal adiposity

80
Q

What are risks the mother faces if she has GDM?

A

–Eclampsia
–Preterm delivery
–C-sec
–Macrosomia + shoulder dystocia &/or brachial plexus injury
–Fetal demise if uncontrolled, stillbirth
–Inc risk type 2 DM postpartum

81
Q

What are fetal risks if mom has GDM?

A 
–Sacral agenesis (rare)
–PP
•Neonatal hypoglycemia/ hyperinsulinemia
•RDS
•Later life obesity &/or type 2 DM
82
Q

When should you screen moms for GDM?

A

•Risk factors/no overt DM
– 1 or 2 step approach: initially & again @ 28-32 wks
•No risk: fasting glucose as part initial lab work
–1 or 2 step approach @ 28-32 wks

83
Q

What is the one step glucose screen for GDM?

A

Fasting glucose then drink 75 g oral solution & draw blood @ 1 & 2 hours (2 H GTT)

84
Q

What abnormal labs are diagnostic of GDM?

A

–Abnormal fasting > 92
–Abnormal 1 H > 180
–Abnormal 2 H > 153
–If fasting > 125 or 2 H > 199 = DM (normal not G)

85
Q

What is the 2 step glucose screen?

A

•Non fasting - drink 50 g oral solution & draw blood 1 H later
IF ABNORMAL at 1 hr, need a 3 hr GTT
–Fasting glucose then drink 100 g oral solution & draw blood @ 1, 2 & 3 hours

86
Q

What constitutes and abnormal 1hr level?

A

> 130-140… depends on lab

87
Q

For the 3 hr GTT in the 2 step glucose screen, what are the abnormal values? How many are needed to diagnose GDM?

A 
–Abnormal fasting > 105
–Abnormal 1 H > 190
–Abnormal 2 H > 165
–Abnormal 3 H > 145
NEED 2/4 to DIAGNOSE
88
Q

What PO agents can be used to control GDM?

A

Glyburide and metformin

89
Q

What fetal monitoring needs to happen is GDM?

A

Daily: FM and kick counts

@ 32 weeks: NST/BPP, US: EFW

90
Q

What are some rules for delivery if GDM?

A

NO POST DATE DELIVERY

Baby >4500g is C section

91
Q

When should maternal glucose levels be rechecked?

A

After delivery and 6-12 weeks later

92
Q

How should candida infection be tx during preggo?

A

Topical azoles x 7 days

93
Q

Should bacterial vaginitis be treated in pregnancy?

A

Only is symptomatic… unclear risk of preterm delivery since flagyl crosses placenta

94
Q

What is trichomonas infection associated with in pregnancy?

A
  • Inc’d risk PROM, premature birth, LBW

* Associated w/vertical transmission HIV

95
Q

How is trichomonas tx?

A

Flagyl PO 500mg BID x 7days…crosses placenta and gets into breast milk

96
Q

If your pt has a hx of known exposure or prior tx for gonorrhea, when should they be rescreened?

A

1st antenatal visit and 3rd trimester

same screening as Chlamydia

97
Q

What is 1t line tx for gonorrhea in preggo? What does the neonate have to receive at birth?

A

ceftriaxone (Rocephin) 250 mgIM/single dose & 1 g azithromycin
erythromycin ophthalmic ointment

98
Q

If mom has Chlamydia what is first line tx?

A

Azithromycin 1g PO single dose

99
Q

What should baby be monitored for if mother had Chlamydia/ was tx for?

A

neonate purulent conjunctivitis 5-12 days s/p birth or pneumonia 1-3 months

100
Q

Is vaginal delivery ok if positive for HSV?

A

NO C section …RX doesn’t guarantee safe delivery.. recurrence rate high

101
Q

What should be done 3rd trimester is partner has HSV?

A

Abstinence

102
Q

What is tx for HSV? Suppressive Rx?

A

acyclovir (po or IV – if severe)

acyclovir 400 mg TID or valacyclovir 500 mg BID

103
Q

What tx for HPV are contraindicated in pregnancy?

A

–Sinecatechins, podophyllin & 5-FU

Imiquimod

104
Q

How should HPV be mamaged in preggo?

A

Elective c section, and defer tx until post partum

105
Q

What can happen to neonates with mothers infected by HPV? Does C-section prevent?

A

rare laryngeal papillomatosis

NO it does not

106
Q

What is the issue with T pallidum?

A

It crosses the placenta

107
Q

What should screening for syph be and when should it be done?

A

RPR and FTA

Initial PN visit then again 3rd trimester

108
Q

What is first line tx for preggo with syphilis?

A

benzathine LA 2.4 single or weekly x 3

109
Q

What can be a complication of syphilis tx?

A

Jarisch- herxheimer rxn….Precipitate preterm labor or fetal distress due to febrile response 24 hrs post PCN
Make sure to get pt in stat

110
Q

What would be s/s of congenital syphilis? ( if mom untreated)

A

Snuffles, saddle nose, Hutchinson teeth, mulberry molars, saber shins, chorioretinitis

111
Q

When should HIV screening be done?

A

1st antenatal visit & & repeat 3rd trimester

112
Q

What can be done antepartum to reduce transmission? Intrapartum?

A

Antiretroviral

c-section

113
Q

What should you do if your preggo pt tests positive for hep b surface antigen?

A

Report to public health ad refer to specialist

114
Q

Why is there universal screening for Group B strep? When is it performed?

A

To prevent neonatal sepsis, pneumonia, meningitis

35-37weeks recto vaginal culture

115
Q

What happens if mom tests postitive for GBS?

A

IV antibiotic prophylaxis 4 hrs pre-delivery through ROM & L&D
PCN/ampicillin or cefazolin

116
Q

What can happen to the fetus if there is 1st trimester exposure to rubella?

A

SAB, congenital rubella syndrome (deafness, cataracts, heart defects (PDA), mental retardation)

117
Q

After receiving which vaccines should women try not to get pregnant for at least 4 weeks?

A

Rubella, varicella

118
Q

What is congential varicella syndrome?

A

1st or early 2nd trimester maternal infection: LBW, scarring on skin, limb hypoplasia, microcephaly

119
Q

If mom has exposure, what should happen>

A

VZIG within 72 hrs… doesn’t protect fetus

120
Q

What if mom has exposure then develops a rash and or pneumonia?

A

acyclovir w/in 24 hrs (pneumonia associated w/inc’d maternal mortality)

121
Q

What if mom developes rash 5 days prior to delivery up through 2 days pp?

A

Neonate at risk for varicella

122
Q

Which pts should be screened for CMV?

A

w/short febrile illness, clinical suspicion, hx transfusions, HIV/AIDS

123
Q

What lab findings indicate an acute infection with CMV?

A

4 fold increase in CMV titers 10-14 days apart

124
Q

What are neonatal risks associated with CMV?

A
  • Microcephaly, hydrocephaly, chorioretinitis, fetal hydrops

* Long term: hearing loss, neurological disabilities

125
Q

How are moms infected with toxoplasmosis?

A

Contact w/infected cat feces

Improperly cooked meat or raw meat

126
Q

When should mom be screened for toxo?

A

1st visit, if low or negative titers and hx of exposure, repeat at week 20 and pre-delivery

127
Q

What will labs look like in acute infection with toxo?

A

•Elevated IgM
•IgG titers > 1:1000
•4 fold increase in IgG antibodies
Rapid rise in either titer

128
Q

Toxoplasmosis has what kind of transmission? what does that mean?

A

Vertical….means damage to fetus is more severe the earlier the transmission occurs

129
Q

What are potential risks associated with toxo infection?

A

SAB, stillbirth, congenital anomalies (blindness, brain damage)

130
Q

What risks are associated with parvo virus B19 ?

A

risk SAB, hydrops or fetal death d/t hydrops

131
Q

What is hydrops fetalis?

A

severe anemia, high-output cardiac failure, extramedullary hematopoiesis

132
Q

What is congenital infection syndrome?

A

rash, anemia, hepatomegaly & cardiomegaly

133
Q

If mom is positive IgM- acute infection, what should be done for fetal evaluation?

A

US and obtain amniotic fluid or fetal blood for B19 DNA

134
Q

What needs to be done if fetus has hydrops?

A

Intrauterine transfusion and further evalv

OB (11 decks)

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