Day 14 - Ob1

Question 1

Change responsible for physiologic anemia of pregnancy & At what gestational age is it most apparent & When should it be tx w/ iron

Answer 1

Greater increase in plasma volume compare to red cell mass; Most apparent in 2nd trimester; Tx when Hb falls below 11 (1st & 3rd trimesters), 10.5 (2nd trimester)

Question 2

Signs of pregnancy: Goodell’s sign

Answer 2

Softening and cyanosis of cervix at 6 wk GA

Question 3

Signs of pregnancy: Chadwick’s sign

Answer 3

Bluish discoloration of vagina due to vascular congestion at 8-12 wk GA

Question 4

Signs of pregnancy: Hegar’s sign

Answer 4

Softening of uterus at 6 wk GA

Question 5

Dose of folic acid recommended to mothers for prevention of neural tube defects

Answer 5

400 mcg (or 0.4 mg) to all women of child-bearing years; Higher doses reduce risk of neural tube defects even more; Note: Anticonvulsants require higher folic acid supplementation; If previous child w/ neural tube defect, 4 mg daily for month prior to pregnancy

Question 6

Additional calories needing during pregnancy/breastfeeding

Answer 6

Pregnancy: 340 kCal a day (2nd trimester); 452 kCal a day (3rd trimester); Breastfeeding: 500 kCal a day (only really need additional 300 because can mobilize fat stores from pregnancy)

Question 7

Indications for PUBS

Answer 7

Percutaneous umbilical blood sampling (aka cordocentesis): In most cases, amniocentesis is sufficient and definitely safer; (1) 2nd and 3rd trimester when karyotype results required within a few days (2) Dx fetal hypo/hyperthyroidism (3) Dx/Mgt fetal thrombocytopenia

Question 8

Nagel’s rule for estimating delivery rate

Answer 8

LMP + 7 days - 3 months + 1 yr = Estimated delivery date

Question 9

Vaccinations for & contraindicate in pregnancy

Answer 9

SAFE: Pnemococcal, Hep A, Hep B, Tetanus (Td, dosed in 2nd or 3rd trimester), Influenza NOT intranasal (dosed in 2nd or 3rd trimester) ; CONTRAINDICATED (live vaccines): MMR, Varicella zoster, Oral polio, Intransal Influenza, etc.; POSTPARTUM/ABORTION: If Rubella non-immune, give Rubella vaccine; If no hx of Tetanus in last 10 yrs, give Tdap (note: Td given in pregnancy but need ap once as an adult - prevents spread of whooping cough to children); If no disease/immunization hx of varicella & serology confirms no immunity, then vaccinate prior to d/c & give 2nd dose 4-8 wks after 1st

Question 10

How Beta-HCG change in early pregnancy

Answer 10

Beta-HCG doubles every 48 hrs; If not doubling, suspect ectopic pregnancy

Question 11

Where find uterus on exam throughout pregnancy (likely not that important for Step 2)

Answer 11

12 wks - pubic symphysis; 16 wks - midway from symphysis to umbilicus; 20 wks - umbilicus; (Afert 20 wks) 21-36 wks - height in cm of fundus from symphysis correlate to GA

Question 12

Gestational HTN

Answer 12

Mild HTN w/ no proteinuria or preeclampsia sx

Question 13

Tx gestational HTN

Answer 13

BP

Question 14

30 yo F HTN currently on ACEi, just discovered she’s pregnant, knowing teratogenicity, switched to different med for HTN - Antihypertensives for pregnancy

Answer 14

First-line: Methyldopa (same as alpha-Methyldopa); Labetalol; Hydralazine, Nifedipine, Amlodipine, Thiazides (as long as volume depletion avoided)