Day 1 Learning Flashcards
When should an echo be done for a fetus in utero?
22-24 weeks
What does AMA stand for in OBGYN?
Advanced medical age
Where should the cord exit the placenta and what are common deviations?
Centrally; common to see it exit marginally with twins
What are the 4 main conditions searched for on carrier screenings?
CF, Fragile-X, Sickle-cell, Spinal Muscular Atrophy
What do positive anti/Ro and anti/La antibodies increase risk for in baby?
Neonatal lupus and fetal heart block (may need pacemaker if block is bad enough)
When is an amniocentesis usually done?
16-22 weeks
What antidepressant is good to give in pregnancy?
Sertraline
What does hx of anxiety and depression in pregnancy lead to?
Increased risk of postpartum depression
Can cleft palates be ruled out on US? What is an indicator?
No; look for lips - if normal appearing, decreased risk for cleft palate
What are complications that can occur on baby with mom having GDM?
Macrosomia, neonatal hypoglycemia, hyperbilirubenemia, shoulder dystocia, birth trauma
When is screening for GDM performed?
24-28 weeks
What is the screening process for GDM?
2-step:
1) 50g oral glucose followed by 1 hour venous glucose determination
2) 100g, 3 hour diagnostic OGTT (oral glucose tolerance test)
What medication(s) is given to women in preterm labor?
Magnesium sulfate and steroids
Why is mag sulfate given to women in preterm labor?
Neonate neuroprophylaxis and tocolysis (slow/stop contractions)
When and why are steroids given to pregnant women?
If women goes into preterm labor 2 doses 24 hours apart…2 more doses 2 weeks later 24 hours apart; given to help advance fetal lung maturity
What drug can be given along with magnesium sulfate and corticosteroids in a patient in preterm labor and why?
Nifedipine - can be given for tocolysis (tocolytics are not always indicated nowadays)
What is considered AMA and what testing is recommended in this patient?
35 or older by the estimated due date and amniocentesis is recommended
What medication is given to patients with an increased risk for preeclampsia, preterm labor, or poor fetal growth, why, and how when should it be given?
Baby aspirin; to reduce risk of all of the mentioned complications; started between 12-28 weeks and continued throughout the rest of the pregnancy
What does a BP of greater than 160/110 in a pregnant women increase risk for?
Greatly increase risk of MI and stroke in mom
What can surgery in the abdomen during pregnancy increase the risk of?
Labor and bleeding at surgical site due to stretching
What is the inheritance pattern for sickle cell disease?
Autosomal recessive
What medication and what dosage should be given to patients with previous anencephaly?
4 mg of folate
What is echogenic bowel and what is it associated with?
Bowel appears bright like bone on US; increased risk for chromosomal abnormalities (i.e. Down’s syndrome, CF, etc.)
What is vasa previa?
Umbilical vessels lying over or near the birthing canal
What is considered fetal growth restriction?
Fetal weight or abdominal circumference less than 10th percentile
What are the qualifications for small gestational age (SGA)?
Newborns whose birth weight is less than the 10th percentile
What infection accounts for most cases of infection-related fetal growth restriction worldwide?
Malaria
What are the four biometric measures most commonly used to assess for fetal growth restriction?
Biparietal diameter, head circumference, abdominal circumference, and femur length
What should be performed at each prenatal care visit after 24 weeks gestation?
Fundal height measurements
What does a discrepancy between weeks of gestational age and fundal height measurement of greater than 3 mean?
May have fetal growth restriction
What should be assessed once fetal growth restriction is diagnosed?
Serial umbilical artery Doppler velocimetry
When is delivery suggested in a women with a baby measuring 3rd-10th percentile with a normal umbilical artery Doppler?
38 0/7 - 39 0/7 weeks
When is delivery suggested in a women with a baby measuring less than the 3rd percentile with a normal umbilical artery Doppler?
37 0/7 weeks
When is delivery suggested in a women with a baby measuring 3rd-10th percentile with an abnormal umbilical artery Doppler?
Earlier than 37 0/7 weeks
What type of diet is recommended in a patient with GDM?
Similar to keto but can have some complex carbs
What is the composition of hemoglobin A?
2 alpha-chains and 2 beta-chains
What is the composition of hemoglobin F?
2 alpha-chains and 2 gamma-chains
What is the composition of hemoglobin A2?
2 alpha-chains and 2 delta-chains
What chromosome are genes that code for alpha-globin located on?
16
What chromosome are genes that code for beta-globin located on?
11
What is the genetic mutation that causes sickle cell disease?
Single nucleotide substitution of valine for glutamic acid coding for beta-globin polypeptide
What is Hb SS, what organ complication is associated with it and what does this result in?
Hb SS - hemoglobin structure in sickle cell disease; patients with Hb SS are functionally asplenic due to autosplenectomy by adolescence; increased incidence and severity of infection
Look up video on velamentous placenta!!
Do it
What is the most significant threat to patients with sickle cell disease and what does this entail?
Acute chest syndrome; pulmonary infiltrate with fever that leads to hypoxemia and acidosis - infiltrates are not infectious in origin but are due to vasoocclusion from sickling or embolization of marrow from long bones affected by sickling
How are hemoglobinopathies diagnosed?
Hemoglobin electrophoresis and CBC
What do thalassemias ultimately result in?
Microcytic anemia
What are the different categories of alpha-thalassemia and their associated sxs?
1 alpha mutation - silent mutation - no effect
2 alpha mutations - alpha-thal trait/minor - mild asymptomatic microcytic anemia
3 alpha mutations - HbH - mild to moderate hemolytic anemia
4 alpha mutations - Hb Bart’s - hydrops fetalis
What ethnicity is commonly associated with trans deletion in alpha thalassemia trait and what effect does this have on inheritance?
African; Hb Bart’s not typically developed in patients of African origin due to (alpha - / alpha -)
What ethnicity is commonly associated with a cis deletion in alpha-thalassemia trait?
Asian
What type of hemoglobin is absent in beta-thalassemia?
HbA
What are the classifications of beta-thalassemia?
Beta-thal minor - heterozygous mutation
Beta-thal intermedia - homozygous mutation with less severe clinical complications
Beta-thal major - homozygous mutation with more severe clinical complications
What are the complications associated with beta-thal major?
Sever anemia with resultant extramedullary hematopoesis, delayed sexual development, and poor growth. Elevated HbF levels and death usually occurs by age 10 unless early intervention by blood transfusions.
What ethnicities are at higher risk for hemoglobinopathies and should therefore be offered carrier screenings?
African, southeast Asian, and Mediterranean
What is recommended for expecting parents where both parents are carriers for potential disorders?
Genetic counseling
When should chorionic villus sampling (CVS) be done?
10-12 weeks
How much folate should a patient with sickle cell disease take and why?
4 mg; continual turnover of red blood cells
What drug is commonly used in patients with lupus and can it be used in Pregnancy?
Hydroxyurea - reduces the frequency of painful crises; cannot be used in pregnancy because it is teratogenic
What are pregnant women with sickle cell disease at an increased risk for?
Spontaneous abortion, preterm labor, IUGR, and stillbirth
When is the best time to deliver a pregnant patient with oligohydramnios?
36-38 weeks
What is an EIF and why is it significant?
A bright spot on the heart (similar to bone); indicates increased risk for Down Syndrome
What does EIF stand for?
Echogenic intracardial focus
What is a common risk factor associated with obesity?
Stillbirth
What is the treatment plan for a neonate with an ASD?
Prostaglandins can be given initially; if unsuccessful, cardiac catheterization
What are the best medications for HTN post-parturition?
Labetalol (1st line); can use nifedipine (procardia) if cannot use labetalol
What does an absent nasal bone on US indicate?
Increased risk of Down Syndrome
What is “normal” fetal positioning?
Head first
What is breech fetal positioning?
Feet/butt first
What is fetal fibronectin and what does it test used for?
The “glue” that holds the amniotic sac to the lining of the uterus; tested to see if the patient is at higher risk for preterm labor
What is velamentous cord insertion?
An abnormal cord insertion in which the umbilical vessels diverge as they traverse between the amnion and chorion before reaching the placenta
