Day 14 - Ob2

Question 1

Hyperemesis gravidarum distinguished from normal morning sickness

Answer 1

Weight loss exceeding 5% of pre-pregnancy body weight, Detection of ketone urea due to starvation

Question 2

W/u Hyperemesis gravidarum

Answer 2

Wt., Orthostatic bp, Serum free T4, electrolytes, urine ketones; Expected lab abnormalities w/ vomiting (including elevations of AST & ALT, not more than 1000, Lipase, Amylase, not more than 5x normal, Bili); US to detect gestation trophoblastic disease (molar pregnancy - HTN & hyperemesis in first trimester, multiple gestations - hyperemesis)

Question 3

Tx Hyperemesis gravidarum

Answer 3

Conservative mgt; Choice: Vitamin B6; Doxylamine (sleep aid); Ginger; May use ry to avoid i can have something safer works: Promethazine, Ondansatron, Metoclopramide; IVF w/ multivitamins & thiamine, if necessary; If refractory & losing weight, NG tube feeds as last resort

Question 4

Adverse effects w/ maternal marijuana use

Answer 4

Smoking at least 6 joints per wk, then small head circumference for age at all ages; No prematurity or congenital anomalies; Increases risk of using alcohol and cigarettes; Later in life - increased incidence of psychiatric problems (ADHD, depression, substance abuse) & certain cancers (Non-lymphoblastic leukemia, Rhabdomyosarcoma, Astrocytoma)

Question 5

Teratogenic effects seen w/ ACEi/ARBs

Answer 5

Renal tubular dysplasia, Renal failure, Oligohydramnios, IUGR, Limb contactures, Pulmonary hyperplasia, Lack of cranial ossification (facial malformations), in utero death

Question 6

Doses of radiation considered safe in pregnancy

Question 7

Congenital findings assoc w/ new varicella infx during pregnancy

Answer 7

Skin dermatomal scarring, Chorioretinis, Cataracts, microopthalmopathy?, nystagmus (EYES), microcephaly, cortical atrophy, mental retardation, dysplasia of hands/feet, low birthweight, early death

Question 8

Congenital defects assoc w/ maternal zoster reactivation

Answer 8

None

Question 9

When to provide intrapartum GBS ppx

Answer 9

Vaginal rectal screening (swab culture) at 35-37 wks; If GBS bacteruria during current pregnancy, then calls for intrapartum GBS ppx; History of early onset GBS infx in prior infant, intrapartum fever, preterm labor, prolonged ROM (regardless of GBS screening results)

Question 10

Antibx used for intrapartum GBS ppx

Answer 10

Penicillin G (preferred); Ampicillin; If pen allergic, only rash - Cephalexin; airway compromise - GBS cultx to determine sensitivity (Clindamycin, Erythromycin); If not know sensitivity, then use Vancomycin; Tx last 4 wks

Question 11

Exposure to rubella in utero - findings

Answer 11

IUGR, radiolucent bone, hepatosplenomegaly, thrombocytopenia, purpuric skin lesions (blueberry muffin rash), hyperbili; sensorineural deafness, cataracts/glaucoma, cardiac (PDA, pulmonary artery stenosis); Neuro (meningeal encephalitis, behavioral disorders)

Question 12

Congenital defects assoc w/ in utero CMV infx

Answer 12

90% asymptomatic at birth - 15% of these develop progressive hearing loss (usually unilateral); Defects at birth - SGA, hepatosplenomegaly, petechiae/purpura, jaundice (similar to Rubella); Neuro (microcephaly, seizure, intracranial calcifications/chororetinitis/hydrocephalus - like Toxo); Thrombocytopenia, hemolytic anemia

Question 13

Feat. of congenital syphilis

Answer 13

Early - hepatosplenomegaly, elevated LFTs, hemolytic anemia, jaundice, rash (followed by desquamation of hands and feet), snuffles (blood tingled nasal secretions), Radiographic changes at birth (metaphyseal dystrophy, periostitis); Late (if not tx) - Hutchinson’s teeth, Saddle nose, Frontal bossing, Saber shins (anterior bowing of tibia)

Question 14

Indications for MTX for ectopic pregnancy (rather than surgical excision)

Answer 14

Hemodynamically stable, Reliably compliant pt w/ posttx monitoring, pre-treatment serum B-HCG